[Cerebral protection with selective cold blood cerebral perfusion by gravity during aortic arch reconstruction]

Selective cold blood cerebral perfusion by gravity using specially designed reservoir with a built-in heat exchanger was applied to 30 consecutive patients who required aortic arch reconstruction. Rectal and brain temperature during cerebral perfusion were maintained at 22 degrees C and 16 degrees C respectively. Patients were divided into two groups according to postoperative condition of consciousness. Twenty three patients had uneventful recovery of consciousness (Group-1), and 7 patients showed delayed recovery or disturbance of consciousness (Group-2). Age, sex, causes of aneurysm, rectal temperature and conditions of cerebral perfusate were not statistically significant in both groups. Selective cerebral perfusion time in Group-1 was 68 +/- 36 min and 85 +/- 31 min in Group-2 (statistically not significant). Extracorporeal circulation time in Group-2 (243 +/- 61 min) was significantly longer than in Group-1 (187 +/- 56 min) (p < 0.05). Five of seven patients (71%) in Group-2 were in shock pre- or early post-operative period contrary to 0% in Group-1 (p < 0.001). These results suggest that selective cold blood cerebral perfusion protects effectively the brain during aortic arch reconstruction in the patients without hemodynamic deterioration.