Aortic arch surgery with a single centrifugal pump for selective cerebral perfusion and systemic circulation

Area of Science:

• Cardiovascular Surgery
• Thoracic Surgery
• Vascular Surgery

Background:

• Aortic arch surgery typically requires two pumps for systemic and selective cerebral perfusion (SCP).
• Developing a simplified perfusion technique is crucial for improving surgical efficiency and patient safety.

Purpose of the Study:

• To evaluate the efficacy and safety of a new technique using a single centrifugal pump for both systemic perfusion and SCP during total aortic arch replacement.
• To assess the feasibility of this simplified circuit in complex aortic arch pathologies.

Main Methods:

• A single centrifugal pump system was designed, with cerebral perfusion lines branching from the main line.
• The technique was applied to 22 consecutive patients undergoing total aortic arch replacement for aneurysms or aortic dissection.
• Cerebral perfusion parameters, including right radial and left common carotid arterial pressures and regional cerebral oxygen saturation (rSO(2)), were closely monitored.

Main Results:

• The single-pump technique was successfully implemented in 22 patients.
• Two operative deaths (9%) occurred, attributed to pneumonia and lung hemorrhage.
• One patient (5%) experienced a stroke, indicating a low incidence of major neurological complications.

Conclusions:

• The simplified single centrifugal pump circuit is a safe and easily applicable method for aortic arch surgery.
• This technique offers a viable alternative to traditional dual-pump systems, potentially reducing complexity and improving outcomes.
• Further research may explore long-term outcomes and broader application in various aortic arch interventions.