Monitoring of antegrade selective cerebral perfusion for aortic arch surgery with transcranial Doppler ultrasonography and near-infrared spectroscopy.
OBJECTIVE
To evaluate the safety and efficacy of antegrade selective cerebral perfusion (ASCP) during aortic arch surgery as a means of extending the safe period of systemic circulatory arrest using multimodality neuromonitoring to objectively quantify the physiologic responses.


METHODS
In twenty-two patients (all less than age 60) scheduled for repair of an aortic arch aneurysm, preoperative verification of effective collateral perfusion through both the carotid and vertebrobasilar arterial systems was documented with transcranial Doppler ultrasonography (TCD). During cardiopulmonary bypass, the sole arterial inflow from the pump was via the right subclavian artery. The magnitude of ASCP was quantified by TCD using peak middle cerebral artery velocity, while flow adequacy was measured by continuous regional cerebrovenous oxygen saturation (rSO2) using dual-wavelength spatially resolved near-infrared spectroscopy.


RESULTS
All patients experienced an uneventful recovery. Flow in the middle cerebral artery became undetectable at ASCP < 5 ml.kg-1.min-1, so adjustments from a 15-20 ml.kg-1.min-1 baseline were used to maintain rSO2 above 50%. Furthermore, ASCP flow was highly correlated (P < 0.01) with both peak middle cerebral artery velocity and rSO2(r = 0.86 and 0.96, respectively).


CONCLUSIONS
Neuromonitoring guided ASCP may be expected to extend the safe period and is at least partly responsible for the absence of neurologic complications in this patient cohort.
Yu
Q
Q
Department of Anesthesiology, Fu Wai Hospital and Cardiovascular Institute, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100037, China. qinjunyu@hotmail.com
Sun
L
L
Chang
Q
Q
Sun
G
G
Liu
J
J
D000293:Adolescent; D000328:Adult; D001014:Aortic Aneurysm / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D002560:Cerebrovascular Circulation / Q000502:physiology; D002648:Child; D005112:Extracorporeal Circulation / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010477:Perfusion / Q000379:methods; D019265:Spectroscopy, Near-Infrared; D017585:Ultrasonography, Doppler, Transcranial