Atherosclerotic Arch Aneurysm Operations With Perfusion Toward the Aortic Valve

Background: The study objective was to investigate the efficacy of perfusion toward the aortic valve in patients who had undergone total arch replacement for atherosclerotic arch aneurysms. Methods: Transesophageal echocardiography was used to measure the peak velocities of each perfusion method in the aortic arch. The latest 15 patients with perfusion toward the aortic valve in the arch procedure were compared with 15 patients with perfusion toward the aortic arch in other cardiac operations as controls. Between April 2005 and February 2009, 65 consecutive patients underwent total arch replacement for atherosclerotic aneurysms. Among them, 48 patients underwent operations with perfusion toward the aortic valve and were reviewed. Results: The peak forward aortic flow velocities with perfusion toward the aortic valve were 48 ± 26 cm/s before cardiopulmonary bypass and 29 ± 13 cm/s on cardiopulmonary bypass. The velocities with perfusion toward the aortic arch were 67 ± 28 cm/s before cardiopulmonary bypass and 226 ± 114 cm/s on cardiopulmonary bypass (p < 0.001). Of the 48 patients with perfusion toward the aortic valve, postoperative temporary and permanent neurologic dysfunctions occurred in 4 (8.2%) and in 1 (2.0%), respectively. One (2.0%) hospital death occurred. Conclusions: Perfusion toward the aortic valve resulted in a significant decrease in peak forward aortic flow velocity in the aortic arch during cardiopulmonary bypass, which might reduce the risk of erosion or disruption of existing atheroma and ensuing embolic complications in patients with atherosclerotic aneurysm.