[Effect of retrograde cerebral perfusion in preserving cerebral function during circulatory arrest]

The efficacy of retrograde cerebral perfusion (RCP) method was evaluated in 26 patients who underwent aortic arch reconstruction. Surgical procedures were; ascending-proxymal arch replacement involving Bentall type procedures (17 cases), total arch replacement (4 cases), and distal arch replacement (5 cases). The RCP were performed through selective cannulation on the superior vena cava at 18.4 degrees C of the average rectal temperature. The perfusion pressure was 28.3 (+/- 5.9) cmH2O and flow was 360 (+/- 15.4) ml/min. RCP time was 74.1 (+/- 26.2) min. Twenty-four patients survived among 26 patients and 2 patients died after operation. Postoperative consciousness was confirmed in 25 patients. Postoperative neurological complications were 1) delayed arousal 5 cases, 2) delirium 3 cases, 3) respiratory disorders 5 cases, 4) double vision 2 cases, 5) cerebral infarction (CI) 1 case. These complications except-CI were resolved in early postoperative period. And regarding effective time period of RCP, incidence of neurological complications were significantly higher in cases which received RCP over 80 min. Therefore we consider that 80 min is a safety time period. In conclusion, RCP is a useful step for preserving the brain during the operation of graft replacement of aorta involving aortic arch.