[Aortic arch surgery with bilateral cerebral perfusion by isolation of brachiocephalic trunk and left carotid artery].
OBJECTIVE
To evaluate the results of a technique described by Carreira et al. using bilateral antegrade selective cerebral perfusion by isolating the brachiocephalic trunk and the left carotid artery.


METHODS
Fifteen patients were operated between June 2005 and September 2007. Data analysis were performed using Epi Info and statistical significance was set at p<0.05.


RESULTS
Of the 15 patients, 53.3% were male; mean age was 59.86+/-15.4 years; 60% presented with type A acute aortic dissection; 6.7% type B; and 33.3% aneurysm of aorta and arch. Mean CPB and aortic clamping time was 177.6+/-39.4 and 135.9+/-34.0 minutes, respectively. In this group, 86.7% were not submitted to total circulatory arrest, with mean unilateral and bilateral selective cerebral perfusion time of 10.9+/-2.0 and 57.2+/-21.2 minutes, respectively. Mean hypothermic temperature was 23.0+/-2.9 masculineC. Two had left subclavian artery ligature, 60% used separated aortic grafts, and four used aortic endoprosthesis. Three (20%) patients died, all of them in the acute aortic dissection group. There were no neurological complications. The mean follow up time was 11.7+/-9.6 months. Regarding mortality, none of the parameters were statistically significant (p>0.05).


CONCLUSIONS
The technique of bilateral selective cerebral perfusion described by Carreira et al. can be performed by others and presents similar results to the international literature. The excellent neurological outcome and easy bleeding control on surgical sutures lines are the major advantages of this new procedure.
Carreira
Valdo José
VJ
Rede D'or de Hospitais, Casa de Saúde São José, Hospital Samaritano, Rio de Janeiro, RJ, Brasil. vcarreira@cardiol.br
de Oliveira
Denoel Marcelino
DM
Honório
Júlio Faria
JF
Pinheiro
Ivo Thadeu de Freitas
IT
Chissonde
Ezequiel Moisés
EM
Faria
Renato Max
RM
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000784:Aortic Dissection / Q000601:surgery*; D001014:Aortic Aneurysm / Q000601:surgery*; D016122:Brachiocephalic Trunk / Q000503:physiopathology / Q000601:surgery*; D006348:Cardiac Surgical Procedures; D002315:Cardiopulmonary Bypass / Q000379:methods* / Q000592:standards; D002339:Carotid Arteries; D002340:Carotid Artery Diseases / Q000601:surgery*; D002560:Cerebrovascular Circulation / Q000502:physiology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007036:Hypothermia, Induced; D008297:Male; D008875:Middle Aged; D055815:Young Adult