Delivery of antegrade cerebral perfusion during descending aortic reconstruction: a case report

Antegrade cerebral perfusion (ACP) has been demonstrated to be a safe and effective method of providing adequate protection to the brain during hypothermic circulatory arrest. By improving oxygen delivery to the cerebral capillaries, users of this technique have reported fewer temporary neurological deficits in postoperative periods, even after prolonged periods of circulatory arrest. Furthermore, ACP may be delivered with little alteration to the cardiopulmonary bypass (CPB) circuit. Surgical correction of a descending aortic aneurysm can provide a challenge when the left subclavian artery is involved. A period of hypothermic circulatory arrest is required to complete the proximal anastamosis of the graft. Access to the cerebral vessels for selective cerebral perfusion is limited during a left thoracotomy approach. A 54-year-old female presented with a computerized tomography (CT) scan of a descending aortic aneurysm, originating at the base of the left subclavian artery. Surgical intervention using CPB via femoral-femoral cannulation was employed. The patient was systemically cooled to 22 degrees C. Selective antegrade cerebral perfusion was administered via cannulation of the left common carotid artery. Antegrade cerebral perfusion lasted 19 minutes, with improved transcranial oximetry readings. The patient was successfully weaned from CPB. The patient was discharged on postoperative day nine with no evident suquelae. It is believed that the application of ACP in this procedure further improved patient outcome.