Directed retrograde cerebral protection during moderate hypothermic circulatory arrest.
There are many choices for neurologic protection for aortic arch surgery. Although numerous investigators have challenged the efficacy of retrograde cerebral perfusion, we have had good results with our application of this technique. We performed a retrospective review of 8 consecutive patients who underwent surgery from 1 June 2001 through 31 March 2003; the age range was 33 to 97 years. All patients required circulatory arrest and underwent retrograde cerebral perfusion with use of a tourniquet on the patients' left and right arms above the elbow to direct retrograde flow to the brain. Moderate hypothermia (around 24 degrees C nasopharyngeal) was used; circulatory arrest time ranged from 27 to 63 minutes. There was 1 late hospital death due to multiple-organ system failure. There were no neurologic complications (stroke or temporary neurologic dysfunction). There was no substantive neurologic or renal dysfunction in this cohort, in which moderate hypothermia was used. These results are comparable to those reported in the literature for similar patients. We conclude that, for patients who require circulatory arrest, directed retrograde cerebral perfusion at moderate nasopharyngeal hypothermia gives results comparable to those reported with other techniques.
Yacoubian
Vahe
V
Department of Cardiothoracic Surgery, Good Samaritan Hospital, Los Angeles, California 90017, USA.
Jyrala
Aarne
A
Kay
Gregory L
GL
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001013:Aorta, Thoracic / Q000601:surgery; D001018:Aortic Diseases / Q000601:surgery*; D001921:Brain / Q000098:blood supply; D013504:Cardiovascular Surgical Procedures / Q000009:adverse effects; D002560:Cerebrovascular Circulation; D005112:Extracorporeal Circulation / Q000009:adverse effects; D005260:Female; D006324:Heart Arrest, Induced / Q000009:adverse effects; D006801:Humans; D007036:Hypothermia, Induced / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D010477:Perfusion; D012189:Retrospective Studies