[Cerebral protection by retrograde perfusion in the treatment of acute aortic dissection].
Four consecutive patients underwent resection and graft replacement of ascending aorta or aortic arch for acute dissection. Retrograde cerebral perfusion (RCP) was used during circulatory arrest. RCP at 15 degrees C was administered through the superior vena cava. Duration of cerebral ischaemia and cardiopulmonary bypass averaged 33 and 156 minutes respectively. Retrograde perfusion flow was regulated from 100 to 800 ml/minute to maintain an internal jugular vein pressure of about 25 cm H2O. All patients survived. Three patients awoke neurologically intact. Minor neurological disturbance was found in 1 patient, he was discharged from hospital at day 11 without any detectable neurological deficit. This technique was attractive because it provided a dry operative field unencumbered by perfusion cannulas or clamps, facilitated construction of a more secure distal anastomosis, and avoided the risk of further injury resulting from the aortic cross clamp. It seems that RCP allows longer circulatory arrest time.
Chocron
S
S
Service de Chirurgie thoracique et cardiovasculaire, Centre hospitalier universitaire, Besançon.
Taberlet
C
C
Clément
F
F
Alwan
K
K
Mourand
J L
JL
Schipman
N
N
Cordier
A
A
Neidhart
M
M
Etievent
J P
JP
D000208:Acute Disease; D000368:Aged; D000784:Aortic Dissection / Q000601:surgery*; D001014:Aortic Aneurysm / Q000601:surgery*; D001927:Brain Diseases / Q000517:prevention & control*; D002315:Cardiopulmonary Bypass / Q000379:methods*; D005260:Female; D006801:Humans; D007036:Hypothermia, Induced / Q000379:methods*; D008297:Male; D008875:Middle Aged
Protection cérébrale par rétroperfusion dans le traitement des dissections aiguës de l'aorte.