[Strategy for cerebral protection during aortic arch replacement].
We analyzed cerebral protection of twenty-five patients, 11 of whom underwent ascending-arch aortic replacement and 14 underwent aortic arch replacement, supported with cardiopulmonary bypass. Twenty of patients underwent selective cerebral perfusion (SCP) with moderate hypothermic circulatory support; 12 of single SCP, 8 of double SCPs. Major arch branch reconstruction were performed with 11 patients; 3 of triple branches, 2 of double branches and 6 of single branch reconstruction. Cerebral impairment was found in 7 patients (25%) with SCP; 3 of them died of low output syndrome and major bleeding during perioperative period. Four of 17 patients, who survived more than one month, showed cerebral infarction in 2 patients and temporary neurological deficit in 2 patients. Our strategies for cerebral protection are (1) careful cerebral four vessels study, (2) SCP with perfusion pressure more than 40 mmHg and flow rate of 7-10 ml/kg/min under moderate hypothermia, (3) bilaterally double branches perfusion minimally for arch replacement, (4) intensive cerebral monitoring from multiple aspect, (5) pharmacological support with barbiturate or aprotinin, (6) gentle maneuver and reliable major branch cannulation to prevent debris embolism.
Department of Surgery (1), Kanazawa University School of Medicine, Japan.
N
N
Sakakibara
H
H
Urayama
Y
Y
Matsunaga
H
H
Takemura
S
S
Murakami
K
K
Ueyama
M
M
Kawasuji
Y
Y
Watanabe
D000784:Aortic Dissection / Q000601:surgery*; D001013:Aorta, Thoracic / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D002315:Cardiopulmonary Bypass / Q000379:methods; D002544:Cerebral Infarction / Q000517:prevention & control; D002560:Cerebrovascular Circulation; D005260:Female; D006801:Humans; D008297:Male; D010477:Perfusion; D011183:Postoperative Complications / Q000517:prevention & control