Arch repair with unilateral antegrade cerebral perfusion.
OBJECTIVE
Several antegrade cerebral perfusion techniques with differing neurological outcomes are employed for aortic arch repair. This study demonstrates the clinical results of aortic arch repair with unilateral cerebral perfusion via the right brachial artery.


METHODS
Between January 1996 and March 2004, 181 patients underwent aortic arch repair via the right upper brachial artery with the use of low-flow (8-10 ml/kg per min) antegrade selective cerebral perfusion under moderate hypothermia (26 degrees C). Mean patient age was 58+/-12 years. Presenting pathologies were Stanford type A aortic dissection in 112, aneurysm of ascending and arch of aorta in 67, and isolated arch aneurysm in two patients. Ascending and/or partial arch replacement was performed in 90 patients and ascending and total arch replacement in 91 patients (including 27 with elephant trunk). In a subset of patients, renal and hepatic effects of ischemic insult were assessed. Free hemoglobin and lactate dehydrogenase levels were measured pre and postoperatively to identify hemolytic effects of brachial artery cannulation.


RESULTS
Mean antegrade cerebral perfusion time was 36+/-27 min. Three patients with acute proximal dissection died due to cerebral complications. One patient had transient right hemiparesis. Total major neurological event rate was 2.2%. Brachial artery was able to carry full cardiopulmonary bypass flow with mild hemolysis. Renal and hepatic tests showed no deleterious effects of limited ischemia at moderate hypothermia.


CONCLUSIONS
Arch repair with antegrade cerebral perfusion through right brachial artery has excellent neurological results, provides technical simplicity and optimal repair without time restraints, does not necessitate deep hypothermia and requires shorter CPB and operation times.
Küçüker
Seref A
SA
Kardiyovasküler Cerrahi Kliniği, Türkiye Yüksek Ihtisas Hastanesi, Sihhiye, Ankara 06100, Turkey. serefalp@yahoo.com
Ozatik
Mehmet Ali
MA
Saritaş
Ahmet
A
Taşdemir
Oğuz
O
D000293:Adolescent; D000328:Adult; D000368:Aged; D017545:Aortic Aneurysm, Thoracic / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000379:methods; D001916:Brachial Artery; D002545:Brain Ischemia / Q000209:etiology / Q000517:prevention & control*; D002315:Cardiopulmonary Bypass / Q000379:methods; D002406:Catheterization, Peripheral / Q000379:methods; D002560:Cerebrovascular Circulation; D005260:Female; D006461:Hemolysis; D006801:Humans; D007036:Hypothermia, Induced / Q000379:methods; D007668:Kidney / Q000503:physiopathology; D008099:Liver / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D010477:Perfusion / Q000379:methods; D011183:Postoperative Complications