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The Annals of Thoracic Surgery, Vol 42, 273-281, Copyright © 1986 by The Society of Thoracic Surgeons
WH Frist, JC Baldwin, VA Starnes, EB Stinson, PE Oyer, DC Miller, SW Jamieson, RS Mitchell and NE Shumway
Ten patients underwent aortic arch replacement for aneurysmal disease from
1970 to 1985 using a simplified cardiopulmonary bypass (CPB) technique with
partial brachiocephalic perfusion, low CPB flow (30 to 50 ml/kg/min),
moderate systemic cooling (26 degrees to 28 degrees C), and topical
hypothermic myocardial protection. The arterial line from a single pump
head has a Y shape to perfuse the femoral artery (20F cannula) and either
the innominate or left carotid artery (14F). Of the 10 patients (mean age,
58 years) with arch aneurysm (6 atherosclerotic, 2 dissections, and 2
degenerative), 3 had previously undergone major cardiovascular operations.
Concomitant procedures included aortic valve replacement in 4 and coronary
artery bypass grafting in 3. Eight patients survived the procedure, and 1
died three weeks after operation of a ruptured abdominal aneurysm. Among
the survivors, CPB time was 119 +/- 36 minutes (+/- standard deviation),
myocardial ischemia time was 79 +/- 32 minutes, and intraoperative blood
requirement was 5.9 +/- 3.4 units. There were no postoperative strokes.
Neurological complications were only minor and included an asymptomatic
miosis and ulnar nerve paresthesias in 1 patient and transient vocal cord
palsy in another. Applicable in most patients undergoing elective resection
of degenerative and atherosclerotic arch aneurysms and in selected patients
with arch dissections, this simplified technique of brachiocephalic
perfusion without circulatory arrest provides an attractive and safe
alternative; the potential advantages are technical simplicity, reduced CPB
and operating times, and satisfactory cerebral protection.
ARTICLES
A reconsideration of cerebral perfusion in aortic arch replacement
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