Arterial Cannulation and Cerebral Perfusion Strategies for Aortic Arch Operations.
Neurologic injuries following aortic arch operations can be devastating, with stroke occurring in up to 12% of elective operations and significant cerebral dysfunction occurring in up to 25% of cases. The primary challenge unique to aortic arch operations involves interruption of direct perfusion of the brachiocephalic vessels during arch reconstruction. For this reason, neuroprotection is paramount. The 2 main modes of protection are (1) reducing metabolic demand through hypothermia and (2) limiting, or even eliminating, the ischemic period. Preoperative selection of the cerebral perfusion plan for each operation is imperative to maintain maximal diffuse cerebral protection and prevent focal neurologic events.
University of Colorado Denver, Aurora, CO, USA lisa.foley@ucdenver.edu.
Lisa S
LS
Foley
University of Colorado Denver, Aurora, CO, USA.
Katsuhiro
K
Yamanaka
University of Colorado Denver, Aurora, CO, USA.
T Brett
TB
Reece
D001013:Aorta, Thoracic / Q000601:surgery*; D001366:Axillary Artery; D016122:Brachiocephalic Trunk; D002406:Catheterization, Peripheral / Q000379:methods*; D002560:Cerebrovascular Circulation; D006801:Humans; D007036:Hypothermia, Induced; D000066829:Neuroprotection
cardiac anesthesia; cardiac surgery; cardiopulmonary bypass surgery; cerebral metabolism; circulatory arrest; deep hypothermic circulatory arrest; hypothermia for brain protection