Continuous retrograde hypothermic low flow cerebral perfusion during aortic arch surgery

Area of Science:

• Cardiovascular Surgery
• Neurology
• Perfusion Technology

Background:

• Aortic arch surgery presents significant risks, particularly neurological injury, due to the need for circulatory arrest.
• Maintaining cerebral protection during extended aortic arch repairs is a critical surgical challenge.

Purpose of the Study:

• To evaluate the safety and efficacy of continuous retrograde hypothermic low flow cerebral perfusion (CRCP) combined with deep hypothermic systemic circulatory arrest (DHSCA) in patients undergoing aortic arch surgery.

Main Methods:

• Six patients underwent aortic arch surgery utilizing cardiopulmonary bypass (CPB) with a centrifugal pump and aprotinin.
• Systemic cooling to 15.2°C was achieved before initiating DHSCA, followed by CRCP via a bypass line to the superior vena cava.
• Cerebral perfusion was maintained at 250-450 ml/min, with internal jugular vein pressure monitored between 18-25 mmHg.

Main Results:

• Five out of six patients regained full consciousness within 48 hours post-operation without neurological deficits.
• One patient experienced mortality due to cardiac failure; no other major organ complications were observed.
• The duration of CRCP ranged from 24 to 55 minutes (mean 39 minutes).

Conclusions:

• CRCP in conjunction with DHSCA appears to be a viable and potentially neuroprotective strategy for complex aortic arch surgery.
• This technique facilitated successful outcomes in the majority of patients, suggesting its utility in minimizing neurological injury.