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Modified Technique for Retrograde Cerebral Perfusion during Hemiarch Aortic Replacement.

Nicholas T Kouchoukos¹, Marc Haynes¹, Sarah Hester¹

¹Division of Cardiovascular and Thoracic Surgery, Missouri Baptist Medical Center, BJC Healthcare, St. Louis, Missouri.

Aorta (Stamford, Conn.)

|October 12, 2021

Summary

Deep hypothermic circulatory arrest with retrograde cerebral perfusion offers safe and effective brain protection during hemiarch aortic replacement, reducing ischemia and clearing the arterial circulation.

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Area of Science:

Cardiovascular Surgery
Neurosurgery
Anesthesiology

Background:

Optimal brain protection during aortic arch surgery remains debated.
This study evaluates a technique using deep hypothermic circulatory arrest (DHCA) and retrograde cerebral perfusion (RCP).

Purpose of the Study:

To assess the early outcomes of DHCA with RCP for brain protection in hemiarch aortic replacement.

Main Methods:

A 15-year study of 520 patients undergoing hemiarch replacement.
Utilized DHCA (mean 17.1°C, 19.3 min) with a brief RCP interval (mean 6.7 min).

Main Results:

Low in-hospital/30-day mortality (1.2%) and stroke rates (1.4%).
Transient neurologic dysfunction occurred in 3.7%; renal failure in 0.77%.
Median hospital stay was 6 days.

Conclusions:

DHCA with brief RCP is safe and effective for brain protection in hemiarch replacement.
RCP shortens brain ischemia and aids in clearing arterial circulation.