[Aortic arch replacement by simple hypothermic retrograde cerebral perfusion for long cerebral circulatory arrest--a...

We have recently discovered that hypothermic cerebral retrograde perfusion can be performed by simply elevating the central venous pressure in Trendelenburg's position during aortic arch surgery. During deep hypothermic perfusion of the lower half of the body with an occlusion balloon in the descending aorta, oxygen saturated venous blood supplied the brain with oxygen. A successful case is reported. A case was 53 y.o. woman of dissecting aortic aneurysm DeBakey type II, with a true aortic arch aneurysm. Under median sternotomy the right atrium and the femoral artery were cannulated for cardiopulmonary bypass. With the brain under retrograde perfusion at a rectal temperature of 16 degrees C and a central venous pressure of 10-15 mmHg, the ascending to the descending aorta was replaced. Blood flowed into the aortic arch from the arch vessels was blackish in color. Brain circulatory arrest time was 81 min. Postoperative course was uneventful. It is suggested that this simple retrograde cerebral perfusion during hypothermic aortic arch surgery protected the brain for an extended brain circulatory arrest time, and eliminated the need for clamping at the aortic arch and the arch vessels, and simplified the operative procedure.