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Eur J Cardiothorac Surg 2006;29:517-524
© 2006 Elsevier Science NL

Low-flow perfusion via the innominate artery during aortic arch operations provides only limited somatic circulatory support

^a Department of Cardiothoracic Surgery, University Hospital Erlangen, University of Erlangen-Nuremberg, Krankenhausstraße 12, 91054 Erlangen, Germany
^b Department of Anesthesia, University Hospital Erlangen, University of Erlangen-Nuremberg, Krankenhausstraße 12, 91054 Erlangen, Germany

Received 25 September 2005; received in revised form 23 December 2005; accepted 29 December 2005.

^_* Corresponding author. Address: Klinik für Herzchirurgie, University Hospital Erlangen, Krankenhausstrasse 12, 91054 Erlangen, Germany. Tel.: +49 9131 8533319; fax: +49 9131 8532768. (Email: olaf.roerick{at}herz.imed.uni-erlangen.de).

Background: Aortic arch operations in pediatric patients using low-flow perfusion techniques have been standardized to a certain degree, but some of the often-stated beneficial effects have never been proven. Especially, the existence or efficacy of any subdiaphragmal perfusion still remains unclear. Methods: Twenty-six newborn male piglets (10–15 kg) underwent aortic arch surgery under general anesthesia using either low-flow perfusion via the innominate artery (LF, 30 ml/(kg min), 25 °C, n = 12) or conventional deep hypothermic circulatory arrest (DHCA, 20 °C, n = 14). Cortical somatosensory-evoked potentials (SSEPs), carotid, and subdiaphragmal blood flows were measured. The animals of both groups have been randomized to either pH-stat or alpha-stat management on cardiopulmonary bypass (CPB). Results: During low-flow perfusion via the innominate artery only negligible flows of maximum 1–3 ml/min in the femoral arteries were detected, whereas the right carotid artery flow doubled. During reperfusion, serum-lactate and aspartate amino-transferase (AST) levels were significantly higher compared to the circulatory arrest group, whereas alanine amino-transferase (ALT), gamma-glutamyl transpeptidase (gamma-GT), AP, and creatinine did not show any significant differences. Cortical SSEP returned to preoperative values in all but two low-flow animals. There was no return of SSEP in all piglets operated under deep hypothermic circulatory arrest (p < 0.01). Conclusion: Compared to DHCA, low-flow perfusion via the innominate artery provides superior neuroprotection despite higher tissue temperatures. Although collateral blood flow via the subclavian artery and the circulus arteriosus willisii has often been presumed, only ‘trickle-flow’ with some protective potential was detectable in the femoral arteries during low-flow perfusion. Origin of elevated lactate and AST levels seems to be the lower limbs.

Key Words: Low-flow perfusion • Deep hypothermic circulatory arrest • Aortic arch • Collateral blood flow