Antegrade cerebral perfusion with hypothermic circulatory arrest: a case report

Techniques for the surgical correction of aortic aneurysms have steadily improved since the first described successful repair in 1955 by DeBakey et al. Despite these improvements, postoperative neurological complications remain a major factor in determining an adverse outcome. By using Deep Hypothermic Circulatory Arrest (DHCA), Retrograde Cerebral Perfusion (RCP) and now Selective Antegrade Cerebral Perfusion (SACP), the surgeon may provide better cerebral protection during extensive arch reconstruction. A 73-year-old female presented with an abnormal chest X-ray. Computerized tomography scan revealed a 4.5 cm mid aortic saccular arch aneurysm. Surgical intervention using cardiopulmonary bypass (CPB) with systemic cooling to 24 degrees C was employed. SACP was administered via cannulation of the innominate artery and the left common carotid artery using pediatric cannulae. Flow rates of 10 mL/kg/min and perfusion pressures of 60-90 mmHg were employed. Transcranial oximetry was used to monitor cerebral oxygen consumption. Circulatory arrest with SACP lasted for 36 min. Total bypass time was 178 min and myocardial ischemic time was 63 min. The patient was discharged on postoperative day five with no evident sequelae. While RCP has many benefits, SACP as used in this procedure may further improve patient outcome.