Background
Antegrade cerebral perfusion is one of the most reliable methods of organ protection
during hypothermic circulatory arrest for aortic arch surgery. We used a simplified
antegrade cerebral perfusion technique with low mortality and morbidity.
Methods
Between January 2005 and August 2008, 21 patients underwent aortic arch surgery with
unilateral antegrade selective cerebral perfusion through the brachiocephalic artery
and moderate hypothermic circulatory arrest. The mean age for patients was 58.0 ± 11.1 (27–82) years.
Cardiopulmonary bypass was commenced and the ascending aorta was cross-clamped. Patients
were cooled to 22–28 °C, whilst the proximal anastomosis was performed. The brachiochephalic artery was
cannulated using a balloon tipped 15Fr catheter used for retrograde cardioplegia.
Antegrade cerebral perfusion was established at the rate of 10 ml//kg/min. The perfusion pressure was controlled between 50 and 70 mmHg whilst the distal anastomosis was completed.
Results
There were no operative deaths and no permanent neurological deficits. Four patients
had temporary confusion. Mean antegrade cerebral perfusion time was 21.6 ± 8.0 (12–48) min. Eight out of 20 patients had circulatory arrest at 28 °C and their mean circulatory arrest time was 22.8 ± 4.7 (16–32) min.
Discussion
The mortality and neurological outcomes of aortic surgery using unilateral antegrade
cerebral perfusion with moderate hypothermic circulatory arrest produced satisfactory
results. Bilateral cannulation and deep hypothermia appear to be unnecessary in most
cases. The coagulopathy from deep hypothermia is thereby avoided.
Keywords
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Article info
Publication history
Accepted:
March 28,
2009
Received in revised form:
March 23,
2009
Received:
December 2,
2008
Identification
Copyright
© 2009 Published by Elsevier Inc. All rights reserved.
