Experience with antegrade bihemispheric cerebral perfusion in aortic arch operations

• Published in: The Annals of thoracic surgery Vol. 66; no. 2; pp. 493 - 499
• Main Authors: Veeragandham, Ramesh S, Hamilton, Ian N, O’Connor, Christopher, Rizzo, Vincenzo, Najafi, Hassan
• Format: Journal Article Conference Proceeding
• Language: English
• Published: New York, NY Elsevier Inc 01.08.1998; Elsevier Science
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Anesthesia; Anesthesia depending on type of surgery; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Aneurysm, Dissecting - surgery; Aorta, Thoracic - surgery; Aortic Aneurysm, Thoracic - surgery; Biological and medical sciences; Cerebrovascular Circulation - physiology; Cerebrovascular Disorders - etiology; Female; Humans; Hypothermia, Induced; Male; Medical sciences; Middle Aged; Perfusion - methods; Postoperative Complications; Thoracic and cardiovascular surgery. Cardiopulmonary bypass; Time Factors; Human; General anesthesia; Cardiovascular disease; Induced hypothermia; Intraoperative; Induced cardiocirculatory arrest; Result; Cardiopulmonary bypass; Treatment; Perfusion; Anterograde; Aortic arch; Surgery; Technique; Aortic disease; Brain (vertebrata)
• ISSN: 0003-4975; 1552-6259
• DOI: 10.1016/S0003-4975(98)00452-4

Background. Various techniques have been used for cerebral protection in aortic arch operations. Antegrade cerebral perfusion has lost its popularity to hypothermic circulatory arrest to overcome the so-called cluttered operative field. Hypothermic circulatory arrest has its own problems of coagulopathy, time constraints, and prolongation of cardiopulmonary bypass time. Methods. Since June 1986 we have used antegrade bihemispheric cerebral perfusion with moderate hypothermia in 20 patients with aortic arch disease. Twelve patients had aneurysm, 7 had dissection, and 1 had traumatic tear. Five patients had had previous sternotomy for ascending aortic replacement. In addition to arch reconstruction, 7 patients had aortic valve replacement or repair, 2 patients had Bentall procedure, and 3 had selective innominate reconstruction. The mean cerebral perfusion time was 51 ± 29 minutes. In 7 patients the cerebral perfusion time was between 60 and 120 minutes. Results. There was no in-hospital or 30-day mortality. The blood product requirements were significantly less with moderate hypothermia. One patient suffered cerebrovascular accident (5%). None of the 7 patients with cerebral perfusion times of 60 to 120 minutes had any neurologic deficits. These results are superior to those reported for hypothermic circulatory arrest with or without retrograde cerebral perfusion. Conclusions. Antegrade bihemispheric cerebral perfusion is an optimal adjunct for cerebral protection during aortic arch operations.