[Optimal perfusion criteria for deep hypothermic selective cerebral perfusion in patients with aortic aneurysm...

Although selective cerebral perfusion (SCP) might be an useful supportive method for aortic arch surgery, its optimal perfusion criteria has not been established. We studied the relationship between the oxygen saturation of superior vena cava or internal jugular vein (SvO2) and the perfusion hemodynamics during deep hypothermic (DH) SCP in twenty patients (pts) (type A dissection; 10, arch aneurysm; 10). SCP was accomplished by perfusion to the brachiocephalic trunk (BCT) and the left common carotid artery (LCC) using separate pumps. Cardiopulmonary bypass and DHSCP time were 128-312 (222 +/- 43, mean +/- SD) minutes and 25-214 (122 +/- 49) minutes, respectively. The cerebral perfusion pressures (CPP) monitored at the bilateral temporal arteries were 20-60 (47 +/- 9) mmHg and cerebral perfusion flow (CPF) was 0.28-0.7 (0.43 +/- 0.10) L/min/m2. The cerebral perfusion score (CPS) defined as CPP X CPF was 7-39 (20 +/- 8). SvO2 ranged from 79 to 99 (94 +/- 7)%. Two operative deaths were encountered from unrelated causes to SCP in both cases. Cerebral infarction occurred in one patient possibly form prolonged low perfusion with low SvO2. When the safety range of SvO2 in DHSCP was defined as greater than 90%, essential criteria to keep this range was CPP greater than 40 mmHg. In 13 out of 15 pts with SvO2 greater than 90%, CPS were above 15. In conclusion, optimal perfusion criteria for DHSCP was defined as CPP greater than 40 mmHg and CPS(CPP X CPF) greater than 15 considering adequate cerebral oxygen consumption.