Simple hypothermic retrograde cerebral perfusion during aortic arch surgery.

Area of Science:

• Cardiovascular Surgery
• Neurosurgery
• Vascular Surgery

Background:

• Aortic arch surgery necessitates brain protection during circulatory arrest.
• Maintaining adequate cerebral perfusion is critical for preventing neurological damage.

Purpose of the Study:

• To evaluate a simplified method of retrograde cerebral perfusion (RCP) via elevated central venous pressure during aortic arch surgery.
• To assess the efficacy of this technique in maintaining brain metabolism and preventing neurological deficits.

Main Methods:

• Retrograde cerebral perfusion achieved by elevating central venous pressure during hypothermia (15°C).
• Descending aorta occlusion used to perfuse the lower body.
• Evaluation of 14 patients undergoing aortic arch aneurysm repair (median and lateral thoracotomies).
• Monitoring of cerebral circulatory arrest time, oxygen, and lactate extraction.

Main Results:

• Successful retrograde cerebral perfusion was achieved in all 14 cases.
• Cerebral circulatory arrest time averaged 65 ± 14 minutes.
• Significant oxygen and lactate extraction indicated aerobic brain metabolism.
• 11 patients experienced no neurological deficits; 3 had transient loss of consciousness from other causes.

Conclusions:

• Elevating central venous pressure is a simple and effective method for retrograde cerebral perfusion during aortic arch surgery.
• This technique successfully maintained aerobic brain metabolism and protected the brain during prolonged circulatory arrest.
• The simplified approach is compatible with both median and lateral thoracotomy approaches.