Passive retrograde cerebral perfusion during routine cardiac valve surgery reverses middle cerebral artery blood flow and reduces the risk of stroke.
OBJECTIVE
Cerebral complications constitute a major source of morbidity and disability after cardiac valve surgery. These may be the result of macroembolization (air/debris) or inadequate perfusion pressure. In an attempt to reduce the incidence of cerebral vascular accident (CVA)/transient ischemic attack (TIA), we have routinely performed three minutes of passive retrograde cerebral perfusion (PRCP) on all valve cases. Here, we retrospectively determined our perioperative (0-30 day) incidence of CVA/TIA.


METHODS
In all cases, the extracorporeal circuit consisted of an ascending aortic cannula and either one two-stage or two single-stage venous cannulae. Three minutes of PRCP was instituted in all cases upon discontinuation of anterograde cardiopulmonary bypass (CPB) via a shunt distal to the heart/lung machine between the arterial and venous cannulae. Mean systemic blood pressure was maintained at 60 mmHg with Neo-Synephrine. Central venous pressure never exceeded 25 mmHg. In 10 cases, transcranial Doppler ultrasonography (TCD) was used to assess middle cerebral artery (MCA) blood flow. In total, 209 consecutive valve procedures with PRCP (group A) were compared with 164 consecutive valve procedures with no PRCP (group B). All data were compared using Fisher's exact probability test. The incidence of CVA/TIA was also compared with published retrospective and prospective data.


RESULTS
TCD demonstrated blood flow reversal in the MCA after a minimum of 30 s. The incidence of CVA/TIA was 0% (0/209) in group A, and 2.4% (4/165) in group B (p = 0.0386). The incidence of CVA/TIA in published retrospective data is 0.7-3.8% and 4.8-5.2% in prospective data.


CONCLUSIONS
We have demonstrated in 209 consecutive valve cases that, upon discontinuation of CPB, routine three-minute PRCP not only reversed MCA blood flow, but also reduced the incidence of neurologic events.
Quigley
R L
RL
Department of Surgery, Guthrie Clinic, Sayre, Pennsylvania 18840, USA.
Fuller
B C
BC
Sampson
L N
LN
Reitknecht
F L
FL
D002560:Cerebrovascular Circulation / Q000502:physiology*; D002561:Cerebrovascular Disorders / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D005260:Female; D006350:Heart Valve Prosthesis / Q000009:adverse effects*; D006801:Humans; D015994:Incidence; D002546:Ischemic Attack, Transient / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D008297:Male; D012039:Regional Blood Flow / Q000502:physiology; D015424:Reperfusion / Q000379:methods*; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome