Retrograde cerebral perfusion: overview,techniques and results

Abstract

Cardiovascular surgical repair of arch aneurysms is taking a step forward by going backwards by utilizing retrograde cerebral perfusion. Drs ME DeBakey, ES Crawford, DA Cooley and GC Morris first reported successful resection and repair of a fusiform aneurysm of the aortic arch with replacement graft in 1957.¹ Since then, Crawford and Coselli have pursued materials and techniques which have made this procedure, one which generally resulted in high morbidity and mortality, more viable with decreased morbidity and mortality. Increased numbers of patients are now having this repair and are resuming normal healthy lives after the operation. From February 1992 to October 1993, 88 patients were surgically treated by Coselli who utilized retrograde cerebral perfusion with profound hypothermia and circulatory arrest, thus allowing for repairs that under any other conditions probably could not have been achieved successfully. It is evident that a major determinant for the successful clinical results, in addition to surgical technique and skill, was the employment of profound hypothermia and circulatory arrest. This article will review the techniques and results of aortic arch repair utilizing retrograde cerebral perfusion during circulatory arrest with profound hypothermia to lessen the chance of neurological morbidity following surgical replacement of the transverse aortic arch.

Get full access to this article

View all access options for this article.

References

DeBakey ME , Cooley DA , Crawford ES , Morris GC Successful resection of fusiform aneurysm of the aortic arch with replacement by homograft. Surg Gynecol Obst 1957; 105: 656-64.

Raskin SA , Daily LC Aortic aneurysm repair with profound hypothermic circulatory arrest. Perfusion 1992; 7: 245-56.

Yuichi U. , Shigehito M. , Kenzi K. et al. Surgical treatment of aneurysm or dissection involving the ascending aorta and aortic arch utilizing circulatory arrest and retrograde cerebral perfusion. J Cardiovasc Surg 1989; 31: 553-58.

Griepp RB , Stinson EB , Hollinsworth JF , Buehler D. Prosthetic replacement of the aortic arch. J Thorac Cardiovasc Surg 1975; 70: 1051-63.

Svensson LG , Crawford ES , Raskin SA et al. Deep hypothermia with circulatory arrest: determinants of stroke and early mortality in 656 patients. J Thorac Cardiovasc Surg 1993; 106: 19-31.

Crawford ES , Snyder DM Treatment of aneurysms of the aortic arch. J Thorac Cardiovasc Surg 1983; 85: 237-46.

Crawford ES , Saleh SA Transverse aortic arch aneurysm: improved results of treatment employing new modifications of aortic reconstruction and hypothermic cerebral circulatory arrest. Ann Surg 1981; 194: 180-88.

Yasuura K. , Ogawa Y. , Okamoto H. et al. Clinical application of total body retrograde perfusion to operation for aortic dissection. Ann Thorac Surg 1992 ;53:655-58.

Usai A. , Hotta T. , Hiroura M. et al. Retrograde cerebral perfusion through a superior vena cava cannula protects the brain. Ann Thorac Surg 1992; 53: 47-53.

10.

Yamashita C. , Nakamura H. , Nishikawa Y. et al. Retrograde cerebral perfusion with circulatory arrest in aortic arch aneurysms. Ann Thorac Surg 1992; 54: 566-68.

11.

Mills NL , Ochsner JL Massive air embolism during CPB: causes, prevention and management. J Thorac Cardiovasc Surg 1980; 80: 708-17.

12.

Coselli JS , Crawford ES , Beall AC et al. Determination of brain temperatures for safe circulatory arrest during cardiovascular operation. Ann Thorac Surg 1988; 45: 638-42.

13.

Wickey GS , Hicky PR Brain protection during cardiac surgery. In: Hensley FA Jr , Martin DE eds. The practice of cardiac anesthesia. Boston: Little, Brown and Company, 1990: 723.

14.

Ott DA , Frazier OH , Cooley DA Resection of the aortic arch using deep hypothermia and temporary circulatory arrest. Circulation 1978; 58: 1227-31.

15.

Kouchoukos NT Adjuncts to reduce the incidence of embolic brain injury during operations on the aortic arch. Ann Thorac Surg 1994; 57: 240-42.