[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.
Service de Chirurgie thoracique et cardiovasculaire, Centre hospitalier universitaire, Besançon.
S
S
Chocron
C
C
Taberlet
F
F
Clément
K
K
Alwan
J L
JL
Mourand
N
N
Schipman
A
A
Cordier
M
M
Neidhart
J P
JP
Etievent
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.