Is it safe to initiate selective cerebral perfusion with normothermia?
OBJECTIVE
Preceding selective cerebral perfusion (P-SCP) is a method whereby SCP and systemic perfusion start simultaneously, and the arch vessels are clamped. Cerebral circulation is isolated from systemic circulation to avoid cerebral embolization due to detachment of atherosclerotic material from the aorta, caused by the "sandblasting" effect of high-velocity jets of blood exiting the aortic cannula. However, neither the safety of SCP at normothermia nor the influence of extended SCP time has been sufficiently clarified. To clarify the safety of P-SCP, the comparison study of P-SCP and conventional SCP (C-SCP) was performed retrospectively.


METHODS
Fifty-seven patients (C-SCP group: 29 patients; P-SCP: 28 patients) underwent surgery between 1992 and 2002.


RESULTS
Nine (15.8%) in-hospital death occurred; 4 in the C-SCP group (13.8%) and 5 in the P-SCP group (17.9%) (NS). The SCP time was 136.6 +/- 68.5 minutes in the C-SCP group and 195.8 +/- 30.7 minutes in the P-SCP group (p < 0.05). One patient in each group exhibited postoperative neurological dysfunction.


CONCLUSIONS
It may be little dangerous to initiate the SCP with normothermia. P-SCP may be useful in cases in which there is pedunculated atherosclerotic material, or mural thrombus in the ascending and arch aorta.
Imamaki
Mizuho
M
Department of General Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan. imamaki-cuh@umin.ac.jp
Nakajima
Nobuyuki
N
Masuda
Masahisa
M
Ishida
Atsushi
A
Shimura
Hitoshi
H
Miyazaki
Masaru
M
D000328:Adult; D000368:Aged; D000784:Aortic Dissection / Q000601:surgery; D017545:Aortic Aneurysm, Thoracic / Q000601:surgery*; D001831:Body Temperature; D002315:Cardiopulmonary Bypass; D002560:Cerebrovascular Circulation; D005260:Female; D006324:Heart Arrest, Induced; D006801:Humans; D007036:Hypothermia, Induced; D020766:Intracranial Embolism / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D010477:Perfusion