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Intermittent antegrade/selective cerebral perfusion during circulatory arrest for repair of the aortic arch

Department of Extracorporeal Circulation, The Weezenlanden Hospital, Zwolle

R Kok

Department of Extracorporeal Circulation, The Weezenlanden Hospital, Zwolle

P Segers

Department of Extracorporeal Circulation, The Weezenlanden Hospital, Zwolle

A Boogaart

Department of Extracorporeal Circulation, The Weezenlanden Hospital, Zwolle

S Eilander

Department of Extracorporeal Circulation, The Weezenlanden Hospital, Zwolle

I de Vries

Department of Extracorporeal Circulation, The Weezenlanden Hospital, Zwolle

J Ennema

Department of Cardiothoracic Anaesthesiology, The Weezenlanden Hospital, Zwolle

P JA van der Starre

Department of Cardiothoracic Anaesthesiology, The Weezenlanden Hospital, Zwolle

F G Leicher

Department of Cardiothoracic Surgery, The Weezenlanden Hospital, Zwolle

M MP Haalebos

Department of Cardiothoracic Surgery, The Weezenlanden Hospital, Zwolle

If the aortic arch requires repair or replacement due to an aneurysm or dissection, conventional cardiopulmonary bypass (CPB) is not possible during the period in which the aortic arch is excluded from the circulation. This creates a situation in which there is no cerebral circulation. The brain needs adequate protection from this ischaemic insult.

Hypothermic circulatory arrest (HCA), antegrade/selective cerebral perfusion (ASCP) and retrograde cerebral perfusion (RCP) are reported to exhibit their cerebral protective capabilities during procedures involving the aortic arch. HCA can provide adequate protection in procedures of short duration and avoids the complications associated with cerebral perfusion techniques. The main disadvantage of HCA is that the ‘safe’ duration of circulatory arrest is not clearly defined. Topical cooling of the head may enhance cerebral hypothermia and provide additional protection. If longer periods of circulatory arrest are anticipated or occur unexpectedly, we suggest that ASCP can offer improved cerebral protection by providing adequate brain perfusion and improved cerebral cooling. By using a coronary sinus perfusion catheter as a carotid artery cannula, it is not necessary to snare or clamp the carotid arteries. This technique minimizes the chance of damaging the carotid arteries. In this report, we describe our set-up and ASCP perfusion protocol for the surgical repair of an aortic arch aneurysm.

Perfusion, Vol. 12, No. 2, 127-132 (1997)
DOI: 10.1177/026765919701200207


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