An assessment of selective cerebral perfusion via the innominate artery in aortic arch replacement

The Thoracic and Cardiovascular Surgeon
G WozniakF W Hehrlein

Abstract

Maintaining an adequate cerebral oxygen supply is a serious problem in aortic arch surgery. Deep hypothermic circulatory arrest is the most common method used for cerebral protection, but guarantees only a time-limited safety period. Based on experimental investigations, we applied selective cerebral perfusion via the innominate artery alone with only moderate hypothermia (28 degrees C) and without circulatory arrest in 25 consecutive patients undergoing surgical treatment of an aneurysm (n = 10) or acute type-A dissection (n = 15) involving the aortic valve and arch. In every case a test perfusion was carried out to assess whether the cerebral perfusion achieved would be adequate for the whole operation. In no case was the perfusion inadequate. As a new perioperative monitoring system, we used computer-aided topographical electroencephalometry (CATEEM). There were 18 male and 7 female patients, their age was 47.0 +/- 15.1 years (mean +/- SD). Mean time periods were 155.1 +/- 37.3 min for aortic cross-clamping, and 69.3 +/- 35 min for selective cerebral perfusion. Postoperatively, two patients (8%) revealed a temporary left-sided hemiparesis, and 4 patients (16%) died within 30 days. The overall mortality rate was 16% in a foll...Continue Reading

Citations

Oct 18, 2001·Cardiovascular Surgery : Official Journal of the International Society for Cardiovascular Surgery·J YeR Deslauriers
Sep 13, 2005·The Journal of Thoracic and Cardiovascular Surgery·Paolo StassanoMichele Mottola
Jul 30, 2004·The Journal of Thoracic and Cardiovascular Surgery·Nicholas T Kouchoukos, Paolo Masetti
May 18, 2001·The Japanese Journal of Thoracic and Cardiovascular Surgery : Official Publication of the Japanese Association for Thoracic Surgery = Nihon Kyōbu Geka Gakkai Zasshi·S YamashiroY Morishima

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