Recent advances of surgical treatment of aortic arch aneurysm using retrograde cerebral perfusion

Between March 1985 and September 1992, 68 patients underwent the replacement of the arch aorta. To protect the brain we had used selective cerebral perfusion (SCP) in 33 cases, but since October 1990 we have used retrograde cerebral perfusion (RCP) in 35 cases. Compared with SCP, RCP decreased the i...

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Published inKyobu geka. The Japanese journal of thoracic surgery Vol. 46; no. 8 Suppl; p. 682
Main Authors Aomi, S, Hashimoto, A, Imamaki, M, Yamaki, F, Akimoto, T, Sakahashi, H, Hirai, M, Tagusari, O, Koyanagi, T, Koyanagi, H
Format Journal Article
LanguageJapanese
Published Japan 01.07.1993
Subjects
Aneurysm, Dissecting - surgery
Aorta, Thoracic - surgery
Aortic Aneurysm, Thoracic - surgery
Blood Vessel Prosthesis
Cerebral Infarction - prevention & control
Cerebrovascular Circulation
Extracorporeal Circulation - methods
Humans
Hypothermia, Induced
Perfusion
Postoperative Complications - prevention & control
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Summary:Between March 1985 and September 1992, 68 patients underwent the replacement of the arch aorta. To protect the brain we had used selective cerebral perfusion (SCP) in 33 cases, but since October 1990 we have used retrograde cerebral perfusion (RCP) in 35 cases. Compared with SCP, RCP decreased the incidences of cerebral infarction and irreversible cerebral complications from 27% to 4% (p < 0.01), and hospital mortality rate from 27% to 14%. However RCP over 80 minutes made complication of transient consciousness disturbance in 4 of 7 cases (57%). We measured cerebral blood flow (CBF) by transcranial Doppler at middle cerebral arteries in 7 cases. After RCP, CBF decreased between 50% and 10% and could not be detected in 3 cases. Reactive hyperemia occurred in all cases after RCP ended. RCP will increased circulatory arrest time by about 30 minutes according to our clinical data.
ISSN:0021-5252