Andreas Zierer, MD, Marc R. Moon, MD, Spencer J

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Impact of Perfusion Strategy on Neurologic Recovery in Acute Type A Aortic Dissection Andreas Zierer, MD, Marc R. Moon, MD, Spencer J. Melby, MD, Nader Moazami, MD, Jennifer S. Lawton, MD, Nicholas T. Kouchoukos, MD, Michael K. Pasque, MD, Ralph J. Damiano, MD The Annals of Thoracic Surgery Volume 83, Issue 6, Pages 2122-2129 (June 2007) DOI: 10.1016/j.athoracsur.2007.01.041 Copyright © 2007 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 Distribution of perfusion technique by surgical era: Cross-clamping without hypothermic circulatory arrest (HCA) (black), HCA alone (white), HCA with retrograde cerebral perfusion (RCP) (gray). The Annals of Thoracic Surgery 2007 83, 2122-2129DOI: (10.1016/j.athoracsur.2007.01.041) Copyright © 2007 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 Distribution of aortic valve replacement (AVR) (black, bottom) versus no AVR (gray, top) by surgical era. Although AVR was common early in the series, the aortic valve was preserved in 95% of patients since 2001. The Annals of Thoracic Surgery 2007 83, 2122-2129DOI: (10.1016/j.athoracsur.2007.01.041) Copyright © 2007 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 Distribution of hemiarch (black, bottom) versus ascending (gray, top) replacement by surgical era. Most recently, ascending aortic replacement was performed in most patients. The Annals of Thoracic Surgery 2007 83, 2122-2129DOI: (10.1016/j.athoracsur.2007.01.041) Copyright © 2007 The Society of Thoracic Surgeons Terms and Conditions

Fig 4 Distribution of retrograde (black, bottom) versus antegrade (gray, top) rewarming by surgical era. Since the early 1990s, the use of rewarming antegrade after completion of the distal aortic repair steadily increased. The Annals of Thoracic Surgery 2007 83, 2122-2129DOI: (10.1016/j.athoracsur.2007.01.041) Copyright © 2007 The Society of Thoracic Surgeons Terms and Conditions

Fig 5 Incidence of transient neurologic deficit by perfusion technique. The three different perfusion strategies included aortic cross-clamping without hypothermic circulatory arrest (cross-clamp), hypothermic circulatory arrest alone (HCA alone), and hypothermic circulatory arrest with supplemental retrograde cerebral perfusion (HCA & RCP). The Annals of Thoracic Surgery 2007 83, 2122-2129DOI: (10.1016/j.athoracsur.2007.01.041) Copyright © 2007 The Society of Thoracic Surgeons Terms and Conditions

Fig 6 Long-term Kaplan-Meier survival for patients undergoing surgery for acute type A aortic dissection using aortic cross-clamping without the need for hypothermic circulatory arrest: cross-clamping (dashed line), hypothermic circulatory arrest alone: HCA alone (solid line), or hypothermic circulatory arrest with supplemental retrograde cerebral perfusion: HCA &RCP (dotted line). The Annals of Thoracic Surgery 2007 83, 2122-2129DOI: (10.1016/j.athoracsur.2007.01.041) Copyright © 2007 The Society of Thoracic Surgeons Terms and Conditions