Retrograde cerebral perfusion for brain protection in aortic aneurysm surgery

Retrograde cerebral perfusion is used as an adjunct to deep hypothermic circulatory arrest (DHCA) for cerebral protection while dealing with complex aortic lesions.

Sixty-six patients, operated for aneurysms of the aorta using DHCA, were studied. In 52 patients, retrograde cerebral perfusion was used as an adjunct to DHCA for cerebral protection. Forty patients were subjected to surgical correction of ascending aorta lesions, 10 were operated for ascending aorta and arch lesions, eight had distal arch aneurysm repair and eight had surgery for thoracoabdominal aortic aneurysms.

Neurologic dysfunction was reported in 6% of patients. No neurologic complications were reported in any patient who had retrograde cerebral perfusion during the circulatory arrest period.

A major limitation of DHCA is the time constraint imposed, beyond which DHCA in isolation may not be safe. Considering the simplicity and safety involved, more liberal use of retrograde cerebral perfusion as an adjunct to DHCA is advocated.