title: Preliminary results of intermittent retrograde cerebral perfusion during proximal aortic arch surgery.
abstract: OBJECTIVE
  Continuous retrograde cerebral perfusion during aortic arch surgery is associated with cerebral edema. In this report, we describe the clinical use of a new type of intermittent retrograde cerebral perfusion.
  
  
  METHODS
  Fourteen patients with a Stanford type A dissection were included in this study. With the usual method of retrograde cerebral perfusion, about 2,500 mL venous blood is drained from bicaval cannulae into a hard-shell reservoir, and oxygenated blood is perfused through the superior vena caval cannula. The flow rate is 300 mL/min. After about 15 min, retrograde perfusion is discontinued, and drainage from the bicaval cannulae is restarted. When a bloodless field is necessary, perfusion also is discontinued.
  
  
  RESULTS
  Two to seven cycles of intermittent retrograde cerebral perfusion were administered (average, 3.1+/-0.4, mean+/-SD). The total retrograde perfusion time was 36.0+/-1.9 min which was equivalent to 74.8% of the circulatory arrest time. No patient developed edema of the upper body. The time to wake-up was 3 to 14 h (average, 6.5+/-1.0 h). No patient suffered any neurologic complications even though the time of circulatory arrest was greater than 60 min in four cases. Head magnetic resonance imaging or computed tomography was performed in 12 cases, and no evidence of hypoxic brain injury was detected.
  
  
  CONCLUSIONS
  Our clinical experience using a moderate amount of intermittent retrograde cerebral perfusion is superior to continuous retrograde cerebral perfusion for protecting the brain during aortic arch surgery.
authors.affiliation: Department of Surgery, University of Yamanashi, Faculty of Medicine, Nakakoma-gun, Yamanashi, Japan.
authors.forename: Shinpei
authors.initials: S
authors.lastname: Yoshii
authors.forename: Okihiko
authors.initials: O
authors.lastname: Akashi
authors.forename: Masahiro
authors.initials: M
authors.lastname: Kobayashi
authors.forename: Atsuo
authors.initials: A
authors.lastname: Kojima
authors.forename: Samuel J K
authors.initials: SJ
authors.lastname: Abraham
authors.forename: Shunya
authors.initials: S
authors.lastname: Shindo
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Tada
authors.forename: Hiroji
authors.initials: H
authors.lastname: Higuchi
mesh_terms: D000328:Adult; D000368:Aged; D000784:Aortic Dissection / Q000601:surgery; D001013:Aorta, Thoracic / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000601:surgery; D002560:Cerebrovascular Circulation / Q000502:physiology*; D005260:Female; D006801:Humans; D002534:Hypoxia, Brain / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D010477:Perfusion / Q000379:methods*