[Operative management of aortic arch aneurysm using selective cerebral perfusion]

Hypothermic circulatory arrest for aortic arch surgery can be tolerated for a limited period of time. To avoid this disadvantage, we used hypothermic cardiopulmonary bypass (CPB) with selective cerebral perfusion (SCP), in which the femoral artery, right axillary artery (RAA) and left common carotid artery (LCCA) were separately cannulated and perfused by individual pump heads. The pressures of bilateral superficial temporal arteries were monitored to maintain the cerebral perfusion pressure at 50 mmHg. The flow of RAA and LCCA was maintained at 5 ml/min/body weight kg, the pressure of each superficial temporal artery at 50 mmHg and the nasopharyngeal temperature at 20 degrees C. To perform the "open distal repair", the CPB was stopped while cerebral perfusion was maintained. Between 1986 and 1991, 20 patients were operated on with this method. Mean duration of SCP was 169 minutes (73 to 210), and mean duration of CPB was 290 minutes (136 to 472). There was no intraoperative death. Operative mortality rate within 30 days after surgery was 10% (2/20). Neurological sequelae occurred in one patient with emergency operation for acute aortic dissection, into LCC of whom we had trouble in inserting a cannula. It was considered that SCP could be performed for at least 2 hours with the results of good cerebral protection.