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Eur J Cardiothorac Surg 2006;30:906-909
© 2006 Elsevier Science NL

Does retrograde cerebral perfusion via superior vena cava cannulation protect the brain?

Department of Cardio-Vascular Surgery, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland

Received 13 February 2006; received in revised form 11 July 2006; accepted 9 August 2006.

^_* Corresponding author. Address: Rue du Bugnon 46, CH-1011 Lausanne, Switzerland. Tel.: +41 21 314 22 80; fax: +41 21 314 22 78. (Email: kuenzli.family{at}bluewin.ch).

Objective: The retrograde cerebral perfusion via cannulation of the superior vena cava is a widespread method for optimising protection of the brain during hypothermic circulatory arrest. Methods: In 14 cadavers (8 females, 6 males) of the local department of pathology, an examination was performed to check the competence of the valves of the internal jugular veins. After a complete preparation of the superior vena cava, the innominate vein and both internal jugular veins, ligating all side branches, a retrograde perfusion on 7 cadavers was installed, documenting flow and pressure of each internal jugular vein (IJV) in vitro. Afterwards, the veins were opened and their valves inspected. Results: In all 14 cadavers, anatomically and functionally competent valves on the right proximal IJV were found. Only 1/14 cadaver had no valve in the left proximal IJV. Additional rudimentary and incompetent valves could be identified in 1/14 cadaver on the distal right IJV, and in 2/14 cadavers on the left IJV. Retrograde flow measurement of 7/14 cadavers revealed 0 ml/min in 4/7 cadavers, 6 ml/min in 1/7, 340 ml/min in 1/7 and 2500 ml/min in 1/7 cadaver. Conclusions: As a rule, anatomically and functionally competent valves in the proximal IJV are present. In human beings, they obstruct the direct retrograde inlet to the intracranial venous system, which suggests an unbalanced and unreliable perfusion of the brain. Therefore, retrograde cerebral perfusion by cannulating the superior vena cava may help flushing out embolism and supporting ‘the cold jacket’ of the brain. However, its effect of retrograde backflow cannot be a sign of adequate cerebral perfusion.

Key Words: Cardiopulmonary bypass • Deep hypothermic circulatory arrest • Experimental • Retrograde cerebral perfusion

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