title: Optimal arterial cannulation technique for selective cerebral perfusion in thoracic aortic surgery.
abstract: Despite advances in surgical procedures, anesthetic management, and cardiopulmonary bypass, brain injury remains a major source of morbidity and mortality in patients undergoing operations on the thoracic aorta. Here, we report our experience with arch vessel cannulation for selective cerebral perfusion in 32 consecutive patients with thoracic aneurysms who underwent total arch replacement between 1998 and 2000. The innominate vein was divided, and intraoperative epiaortic echography was performed to identify the least atherosclerotic site on brachiocephalic and left carotid arteries before establishment of cardiopulmonary bypass. There were no in-hospital deaths, and only 1 patient (3.1%) had a perioperative stroke. Identifying the least atherosclerotic site in cephalic branches is important for safely establishing selective cerebral perfusion and for preventing perioperative cerebral embolism during total arch replacement.
authors.affiliation: Division of Cardiovascular Surgery, Osaka Police Hospital, Japan. Tohata@aol.com
authors.forename: Toshihiro
authors.initials: T
authors.lastname: Ohata
authors.forename: Tetsuo
authors.initials: T
authors.lastname: Sakakibara
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Takano
authors.forename: Toru
authors.initials: T
authors.lastname: Ishizaka
authors.forename: Masahiko
authors.initials: M
authors.lastname: Tsujimoto
mesh_terms: D000328:Adult; D000368:Aged; D001013:Aorta, Thoracic / Q000601:surgery; D017545:Aortic Aneurysm, Thoracic / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation; D016122:Brachiocephalic Trunk; D002545:Brain Ischemia / Q000517:prevention & control; D002315:Cardiopulmonary Bypass / Q000379:methods*; D017536:Carotid Artery, Common; D002404:Catheterization / Q000379:methods*; D002560:Cerebrovascular Circulation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies