Selective cerebral perfusion for cerebral protection: what we do know.

Area of Science:

• Cardiovascular Surgery
• Neurology
• Perfusion Technology

Background:

• Selective antegrade cerebral perfusion (SACP) is crucial for aortic arch surgery.
• Previous research explored various parameters like temperature, hematocrit, and pH.
• Refinements are needed to optimize SACP protocols for patient safety and outcomes.

Purpose of the Study:

• To establish an optimized protocol for selective antegrade cerebral perfusion (SACP).
• To provide evidence-based recommendations for key perfusion parameters.
• To enhance cerebral protection during aortic arch procedures.

Main Methods:

• Literature review of animal models and clinical research on SACP parameters.
• Analysis of studies investigating pressure, flow rates, temperature, and pH.
• Incorporation of near-infrared spectroscopy (NIRS) for monitoring.

Main Results:

• Recommended SACP protocol: pressure 40-60 mmHg, flow 6-10 mL/kg/min, perfusate temperature 20-28 °C.
• Core cooling to 18-30 °C based on arrest duration.
• Hematocrit 25-30%, alpha-stat pH management, and bilateral perfusion for extended SACP.

Conclusions:

• The proposed SACP protocol optimizes cerebral perfusion and protection.
• Specific parameters for pressure, flow, temperature, and pH are critical.
• NIRS monitoring and bilateral perfusion enhance safety during complex aortic arch surgery.