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Ann Thorac Surg 1998;66:493-499
© 1998 The Society of Thoracic Surgeons

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Original articles: cardiovascular

Experience with antegrade bihemispheric cerebral perfusion in aortic arch operations

^a Department of Cardiovascular-Thoracic Surgery, Rush Medical College and Rush-Presbyterian-St. Luke’s Medical Center, Chicago, Illinois, USA
^b Department of Anesthesiology, Rush Medical College and Rush-Presbyterian-St. Luke’s Medical Center, Chicago, Illinois, USA
^c Rush Heart Institute, Rush Medical College and Rush-Presbyterian-St. Luke’s Medical Center, Chicago, Illinois, USA

Accepted for publication March 29, 1998.

Address reprint requests to Dr Najafi, Department of Cardiovascular-Thoracic Surgery, 1725 W Harrison St, Suite 1156, Chicago, IL 60612

Background. Various techniques have been used for cerebral protection in aortic arch operations. Antegrade cerebral perfusion has lost its popularity to hypothermic circulatory arrest to overcome the so-called cluttered operative field. Hypothermic circulatory arrest has its own problems of coagulopathy, time constraints, and prolongation of cardiopulmonary bypass time.

Methods. Since June 1986 we have used antegrade bihemispheric cerebral perfusion with moderate hypothermia in 20 patients with aortic arch disease. Twelve patients had aneurysm, 7 had dissection, and 1 had traumatic tear. Five patients had had previous sternotomy for ascending aortic replacement. In addition to arch reconstruction, 7 patients had aortic valve replacement or repair, 2 patients had Bentall procedure, and 3 had selective innominate reconstruction. The mean cerebral perfusion time was 51 ± 29 minutes. In 7 patients the cerebral perfusion time was between 60 and 120 minutes.

Results. There was no in-hospital or 30-day mortality. The blood product requirements were significantly less with moderate hypothermia. One patient suffered cerebrovascular accident (5%). None of the 7 patients with cerebral perfusion times of 60 to 120 minutes had any neurologic deficits. These results are superior to those reported for hypothermic circulatory arrest with or without retrograde cerebral perfusion.

Conclusions. Antegrade bihemispheric cerebral perfusion is an optimal adjunct for cerebral protection during aortic arch operations.

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