Selective cerebral perfusion during operation for aneurysms of the aortic arch: a reassessment

Thirty-two consecutive patients with thoracic aortic aneurysms who required aortic arch reconstruction were operated on with the aid of extracorporeal circulation and selective cerebral perfusion between January 1986 and August 1990. For selective cerebral perfusion, blood was infused into both the innominate and left common carotid arteries at a rate of 10 mL.kg-1.min-1 using a single roller pump separately from the systemic circulation. In 9 patients treated before March 1987, the operations were performed without open aortic anastomosis (group 1), whereas in 23 patients treated from March 1987 onward we used open aortic anastomosis (group 2). The extracorporeal circulation and cardiac arrest times were significantly longer in group 2, but there was no significant difference in the cerebral perfusion time. Early death occurred in 1 patient in group 1 and 2 in group 2. No serious cerebrospinal neurological complications occurred in either group, and there were similar rates of postoperative hepatic and renal dysfunction in both groups. The present data suggest that selective cerebral perfusion and open aortic anastomosis are useful methods for thoracic aortic aneurysm operation requiring complex repair of the aortic arch.