Retrograde Cerebral Perfusion for Aortic Arch Operation

Abstract

Deep hypothermic retrograde cerebral perfusion (RCP) has recently been the focus of interest as a simple new technique of brain protection during the operation for thoracic aneurysms. During the period from January 1991 to July 1994, 21 consecutive patients underwent operations on the various portions of the thoracic aorta with the use of deep hypothermic RCP. There were 10 men and 11 women, ages ranging from twenty-eight to seventy-eight (mean 61.4) years old. There were 9 cases with true aortic aneurysm, and 12 with dissecting aneurysm. In 8 patients (38.1%) the procedures were done on an emergency basis for ruptured/impending ruptured aneurysms or acute dissecting aneurysms. Four patients died before the adequate assessment of their neurologic function. One patient had a cerebral infarction probably due to dissection of the left common carotid artery. The remaining 16 patients showed clear consciousness and had no serious neuro logic complications postoperatively. Total perfusion time averaged 297 ± 110 minutes (ranging from 162 to 548 minutes). Rectal temperatures were 20.1 ± 1.4°C (ranging from 18.0 to 22.5°C). RCP time averaged 51.3 ± 13.9 minutes (ranging from twenty-seven to eighty minutes). Blood gas analysis of the returned blood sampled from the left common carotid artery or the innominate artery and the ophthalmoscopic findings demonstrated the insufficiency of blood and oxygen supply to the brain during RCP. Therefore, RCP time should be shortened and pharmacologic cerebral protection is recommended to reduce neurologic complications during operations on the thoracic aorta using RCP.

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