[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 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.
Department of Cardiovascular Surgery, Heart Institute of Japan, Tokyo Women's Medical College, Japan.
S
S
Aomi
A
A
Hashimoto
M
M
Imamaki
F
F
Yamaki
T
T
Akimoto
H
H
Sakahashi
M
M
Hirai
O
O
Tagusari
T
T
Koyanagi
H
H
Koyanagi
D000784:Aortic Dissection / Q000601:surgery*; D001013:Aorta, Thoracic / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D002544:Cerebral Infarction / Q000517:prevention & control; D002560:Cerebrovascular Circulation; D005112:Extracorporeal Circulation / Q000379:methods; D006801:Humans; D007036:Hypothermia, Induced; D010477:Perfusion; D011183:Postoperative Complications / Q000517:prevention & control