Two different techniques of retrograde cerebral perfusion for thoracic aortic surgery through a left thoracotomy.
The authors used profound hypothermic circulatory arrest and continuous retrograde cerebral perfusion for aortic surgery that involved the distal arch through a left thoracotomy. For the first seven patients, oxygenated blood from cardiopulmonary bypass was perfused retrogradely through a venous cannula positioned into the right atrium. In the last 11 cases, venous blood, provided by a perfusion from the lower body, was circulated passively in the brain with the descending aorta clamped. The period of profound hypothermic circulatory arrest was 34.6 +/- 11.1 min, and continuous retrograde cerebral perfusion was 31.3 +/- 11.1 min. Seventeen patients survived, but there was one early death. Two patients with a severely atherosclerotic aneurysm developed permanent neurological dysfunction. The combination of profound hypothermic circulatory arrest, continuous retrograde cerebral perfusion and open aortic anastomosis through a left thoracotomy protects the brain adequately, and facilitates evacuation of debris and air in the aortic arch. It produces satisfactory results for aortic surgery that involves the distal arch.
Ogino
H
H
Department of Cardiovascular Surgery, Tenri Hospital, Nara, Japan.
Ueda
Y
Y
Sugita
T
T
Sakakibara
Y
Y
Matsubayashi
K
K
Nomoto
T
T
D000368:Aged; D017545:Aortic Aneurysm, Thoracic / Q000601:surgery*; D002315:Cardiopulmonary Bypass; D002544:Cerebral Infarction / Q000209:etiology; D002560:Cerebrovascular Circulation; D004618:Embolism, Air / Q000209:etiology; D005260:Female; D006324:Heart Arrest, Induced; D006801:Humans; D007036:Hypothermia, Induced / Q000009:adverse effects / Q000401:mortality; D008297:Male; D009422:Nervous System Diseases / Q000209:etiology; D010100:Oxygen / Q000097:blood; D010477:Perfusion / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D013908:Thoracotomy; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000379:methods* / Q000401:mortality
D010100:Oxygen