Early experience of retrograde cerebral perfusion

Since 1990, retrograde cerebral perfusion has been applied in aortic arch surgery in the Nagoya University group to protect the brain. This study reviews the group's early clinical results, and especially of neurological outcome in patients undergoing aortic arch surgery via mid sternotomy by using retrograde cerebral perfusion only via the superior vena cava. Seventy-three cases (47 men, 26 women; mean age 62.3 (range 26-82 years)) participated in the study. True aneurysm was diagnosed in 17 cases and aortic dissection in 56. Emergency operations were performed in 49 cases (67%). The proximal aortic arch was replaced in 38 cases, the total aortic arch in 21, the distal arch in six, and the aortic root in two. Mean (s.d.) retrograde cerebral perfusion duration was 55(23) (range 12-115) min and superior vena cava flow rate 350(143) ml/min. Excluding four cases of early surgical death, a total of 10 patients (14.5%) showed neurological dysfunction. Symptoms were coma in eight cases and motor paralysis in two. Three of these 10 cases were recovered without symptoms and six died. The early mortality rate was 19.2%. Significant differences in retrograde cerebral perfusion duration (49(20) versus 83(18) minutes, P < 0.001), superior vena cava pressure (23.2(7.2) versus 28.2(7.4) mmHg, P = 0.046), and preoperative cardiac arrest P < 0.05) were evident between groups with and without neurological dysfunction. There were no neurological dysfunctions in patients undergoing retrograde cerebral perfusion for < 60 minutes at under 30 mmHg of superior vena cava pressure. In conclusion, retrograde cerebral perfusion may be used to extend the duration of safe cerebral circulatory arrest.