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European Journal of Cardio-Thoracic Surgery, Vol 6, 36-41, Copyright © 1992 by European Association for Cardio-thoracic Surgery
Y Ueda, S Miki, K Kusuhara, Y Okita, T Tahata and K Yamanaka
From 1987 to February 1991, we have repaired or replaced the aortic arch in
ten patients using deep hypothermic systemic circulatory arrest with
continuous retrograde cerebral perfusion (CRCP). CRCP can be implemented
using the bypass connecting the arterial and venous lines of the
extracorporeal circuit to reverse the flow into the superior vena cava
cannula after induction of circulatory arrest. CRCP flow required to
maintain an internal jugular vein pressure of 20 mmHg ranged from 100 to
500 ml/min. After completion of suturing of the aortic arch graft, air is
evacuated retrogradely from the open arch vessels prior to reestablishing
the usual arterial return. Two patients died, one from sepsis and the other
from liver cirrhosis 1 month postoperatively. CRCP times ranged from 11 to
56 min, and minimal nasopharyngeal temperatures ranged from 16 degrees to
18 degrees C. The difference in oxygen content between the perfused blood
and the blood draining from the arch vessels during CRCP most likely
reflected the steady-state metabolism of the brain during the deep
hypothermic state. This technique offers advantages including the need for
dissecting and clamping the arch branches, providing sufficient metabolic
support to the brain during deep hypothermia, and eliminating embolism of
particulate debris from the aortic arch.
ARTICLES
Deep hypothermic systemic circulatory arrest and continuous retrograde cerebral perfusion for surgery of aortic arch aneurysm
Department of Cardiovascular Surgery, Tenri Hospital, Nara, Japan.
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