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Low-flow perfusion technique for shaggy aortic arch.

Takashi Shuto1, Hirofumi Anai2, Tomoyuki Wada2

  • 1Department of Cardiovascular Surgery, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasama-Machi, Yufu-Shi, Oita, 879-5593, Japan. shutot@oita-u.ac.jp.

General Thoracic and Cardiovascular Surgery
|November 23, 2023
PubMed
Summary

Low-flow perfusion effectively prevents cerebral embolism during aortic arch surgery by maintaining self-cardiac output and achieving deep hypothermia. This method protects against atheroma destruction from blood flow jets.

Keywords:
Cardiopulmonary bypassCerebral embolismExtracorporeal circulationLow-flow perfusionShaggy aorta

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Area of Science:

  • Cardiovascular Surgery
  • Neurology
  • Vascular Surgery

Background:

  • Cerebral infarction is a common complication in patients with thoracic aortic disease and shaggy aorta.
  • Atherosclerotic lesions in the aortic arch pose a risk for cerebral embolism during surgery.
  • Traditional extracorporeal circulation methods may increase embolism risk.

Purpose of the Study:

  • To evaluate the efficacy of "low-flow perfusion" in preventing cerebral embolism during aortic arch surgery.
  • To compare outcomes between low-flow perfusion and normal extracorporeal circulation.
  • To assess the safety and effectiveness of a novel perfusion technique.

Main Methods:

  • A comparative study of 12 patients undergoing "low-flow perfusion" (Group L) versus 12 patients undergoing normal extracorporeal circulation (Group N).
  • "Low-flow perfusion" involves partial blood removal for cardiopulmonary bypass, aiming for deep hypothermia while preserving self-cardiac output.
  • Surgical procedures were performed since 2019 for aortic arch repair.

Main Results:

  • Group L achieved significantly longer cooling times to ventricular fibrillation (9.5 min vs. 3.6 min, p < 0.01).
  • Lower eardrum temperatures were reached in Group L (28.2°C vs. 32.5°C, p = 0.01) at ventricular fibrillation.
  • Blood flow analysis indicated reduced wall shear stress on the aortic arch's lesser curvature in Group L.

Conclusions:

  • Low-flow perfusion facilitates sufficient intracranial cooling without increasing total pump flow.
  • This technique prevents atheroma destruction by mitigating blood flow jet impact.
  • Low-flow perfusion offers a protective strategy against cerebral embolism during aortic arch surgery while maintaining native cardiac function.