Modified Technique for Retrograde Cerebral Perfusion during Hemiarch Aortic Replacement

AORTA

article

Nicholas T. Kouchoukos¹  Marc Haynes¹  Sarah Hester¹  Catherine F. Castner¹ 

[1] Division of Cardiovascular and Thoracic Surgery, Missouri Baptist Medical Center, BJC Healthcare

关键词: brain protection;    hemiarch replacement;    retrograde cerebral perfusion;   

DOI  :  10.1055/s-0041-1726279

来源: Thieme

【 摘 要 】

Background Uncertainty remains regarding the optimal method of brain protection for procedures that require repair or replacement of the aortic arch. We examined the early outcomes of a technique for brain protection in patients undergoing partial aortic arch (hemiarch) replacement that involves deep hypothermic circulatory arrest (DHCA) and retrograde cerebral perfusion (RCP) of cold blood from the superior vena cava toward the end of the arrest interval.Methods During a recent 15-year interval, 520 patients underwent elective or urgent/emergent ascending aortic and hemiarch replacement as an isolated (47 patients) or combined (473 patients) procedure employing DHCA (mean nasopharyngeal temperature at circulatory arrest, 17.1°C and mean duration, 19.3 minutes) supplemented with RCP of cold blood from the superior vena cava toward the end of the arrest interval (mean, 6.7 minutes). The mean age of the patients was 59.5 years, and 65% were male.Results48 hours and five patients (0.96%) required a tracheostomy. The median hospital length of stay was 6 days.Conclusion DHCA with a brief interval of RCP is a safe and effective technique for brain protection during hemiarch aortic replacement. RCP reduces the duration of brain ischemia and permits removal of particulate matter and air from the arterial circulation.

【 授权许可】

Unknown