Functional brain isolation technique for stroke prevention in thoracic endovascular aortic repair

• Published in: European journal of cardio-thoracic surgery Vol. 60; no. 2; pp. 420 - 422
• Main Authors: Tsuda, Kazumasa, Washiyama, Naoki, Takahashi, Daisuke, Shiiya, Norihiko
• Format: Journal Article
• Language: English
• Published: Germany Oxford University Press 01.08.2021
• Subjects: Shaggy aorta; Isolated cerebral perfusion; Thoracic endovascular aortic repair; Stroke
• ISSN: 1010-7940; 1873-734X
• DOI: 10.1093/ejcts/ezab030

Abstract To prevent embolic stroke during thoracic endovascular aortic repair, we have adopted the brain isolation technique since June 2014 in 9 selected high-risk patients (9/134: 6.7%) having ulcerated or protruding atheromas within the proximal aorta. Cardiopulmonary bypass was used to prevent aortic atheromas from entering the brain. We used a heparin-coated closed-loop cardiopulmonary bypass system incorporating a soft reservoir bag with 1 mg/kg heparin to minimize the disadvantages of extracorporeal circulation. The bypass graft (right axillary-left carotid-left axillary) was used as an arterial inflow in patients undergoing zone-1 landing (n = 8), while peripheral cannulation into 3 brachiocephalic arteries was employed in the remaining patient. Initial pump flow was set at 1.3 l/min/m2, and native cardiac output was reduced by adjusting the reservoir bag volume. Aortography was performed to confirm non-visualization of the arch vessels before catheter manipulation. There was no mortality and 1 solitary left cerebellar infarction.