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Eur J Cardiothorac Surg 2005;27:638-643
© 2005 Elsevier Science NL

Arch repair with unilateral antegrade cerebral perfusion

eref A. Küçüker^a,*, Mehmet Ali Özatik^a, Ahmet Sarta^a, Ouz Tademir^b

^a Kardiyovasküler Cerrahi Klinii, Türkiye Yüksek htisas Hastanesi, Shhiye, Ankara 06100, Turkey
^b Cankaya Hospital, Ankara, Turkey

Received 10 September 2004; received in revised form 10 January 2005; accepted 12 January 2005.

^* Corresponding author. Tel.: +90 312 310 3080x1242; fax: +90 312 312 4120. (E-mail: serefalp{at}yahoo.com).

Objective: Several antegrade cerebral perfusion techniques with differing neurological outcomes are employed for aortic arch repair. This study demonstrates the clinical results of aortic arch repair with unilateral cerebral perfusion via the right brachial artery. Methods: Between January 1996 and March 2004, 181 patients underwent aortic arch repair via the right upper brachial artery with the use of low-flow (8–10ml/kg per min) antegrade selective cerebral perfusion under moderate hypothermia (26°C). Mean patient age was 58±12 years. Presenting pathologies were Stanford type A aortic dissection in 112, aneurysm of ascending and arch of aorta in 67, and isolated arch aneurysm in two patients. Ascending and/or partial arch replacement was performed in 90 patients and ascending and total arch replacement in 91 patients (including 27 with elephant trunk). In a subset of patients, renal and hepatic effects of ischemic insult were assessed. Free hemoglobin and lactate dehydrogenase levels were measured pre and postoperatively to identify hemolytic effects of brachial artery cannulation. Results: Mean antegrade cerebral perfusion time was 36±27min. Three patients with acute proximal dissection died due to cerebral complications. One patient had transient right hemiparesis. Total major neurological event rate was 2.2%. Brachial artery was able to carry full cardiopulmonary bypass flow with mild hemolysis. Renal and hepatic tests showed no deleterious effects of limited ischemia at moderate hypothermia. Conclusions: Arch repair with antegrade cerebral perfusion through right brachial artery has excellent neurological results, provides technical simplicity and optimal repair without time restraints, does not necessitate deep hypothermia and requires shorter CPB and operation times.

Key Words: Cerebral protection • Antegrade cerebral perfusion • Brachial artery cannulation

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