[Retrograde cerebral perfusion during circulatory arrest with deep hypothermia. A new technique for brain protection in surgery of ascending aorta and aortic arch].
Between May 1993 and August 1994, 15 patients (10 men) with type A aortic dissection (9 acute) had a replacement of the ascending aorta and/or aortic arch with circulatory arrest with profound hypothermia and retrograde cerebral perfusion. Mean circulatory arrest time was 47.5 min (range 23 to 68 min). Three patients (20%) died in relation to postoperative bleeding. No patient had a new neurologic damage related to surgery. Ten patients were awake and oriented before 24 hours of the operation and another one before 48 hours; 4 patients required more than 48 hours to be completely awake and oriented. Two patients were operated on with a recent stroke. One of them recovered without sequelae before hospital discharge and the other one had a major regression of his brain damage. Two other patients had emergency surgery because of cardiac tamponade and cardiogenic shock. Both of them had a satisfactory recovery. Six patients presented azotemia but only 2 of them needed dialysis. There was no case of Q wave infarction nor congestive heart failure in the perioperative period. Follow-up was 100% completed (12 patients) with a mean of 9.8 months (range 5 to 18 months). One patient died on the 10th postoperative month because of a late infectious process. Eight patients are in functional class I and 3 in II. Ten of them are back to their usual activities'. Although retrograde cerebral perfusion is a new surgical technique, it seems to be a very valuable complement for brain protection in ascending aorta and/or aortic arch surgery with circulatory arrest with profound hypothermia.
Zalaquett
R
R
Departamento de Enfermedades Cardiovasculares, Universidad Católica de Chile, Santiago.
Irarrázaval
M J
MJ
Morán
S
S
Muñoz
C
C
Garayar
B
B
Becker
P
P
Canessa
R
R
Lema
G
G
Medal
J
J
Urzúa
J
J
D000368:Aged; D001011:Aorta / Q000601:surgery*; D001013:Aorta, Thoracic / Q000601:surgery; D002560:Cerebrovascular Circulation; D005260:Female; D006324:Heart Arrest, Induced; D006801:Humans; D008297:Male; D008875:Middle Aged; D010477:Perfusion / Q000379:methods*; D011379:Prognosis; D011446:Prospective Studies; D013997:Time Factors
Perfusión cerebral retrógrada durante paro circulatorio con hipotermia profunda. Nueva técnica para la protección encefálica en cirugía de aorta ascendente y arco aórtico.