Total body retrograde perfusion during hypothermic circulatory arrest is unsafe

Retrograde cerebral perfusion and retrograde inferior vena cava perfusion at a pressure of 25 mmHg can protect brain and visceral organs during hypothermic circulatory arrest. Total body retrograde perfusion has been proposed as an alternative during aortic arch surgery. We describe two patients who received total body retrograde perfusion during hemi-arch replacement. The procedure had to be terminated at 8 and 15 minutes due to severe fluid retention and decline in cerebral oxygen saturation. Delirium occurred in one patient after surgery. We concluded that total body retrograde perfusion may be associated with high risk of hypoperfusion and should not be recommended.