For a study, researchers assessed unilateral cerebral perfusion’s surgical and neurological effects after aortic arch surgery. A total of 1000 patients (mean age 63±12; range 14-88 years) with non acutely dissected aortic pathology (aneurysm, porcelain aorta, chronic dissection, infection, and injury in 89.1%, 4.9%, 4.1%, 1.6%, and 0.3%, respectively) underwent aortic arch surgery using unilateral cerebral perfusion for brain protection using mild hypothermia between June 2004 and February 2017. In 3.6 % of the patients, there had been a previous neurological incident with residuals, and 12.2 % had had previous cardiovascular surgery.
In 346 and 654 patients, total arch repair (with at least one supra-aortic artery involved) or semi arch replacement was performed by researchers. In 521 patients, the aortic valve was replaced (including 190 composite valve grafts), and 380 patients had it repaired (284 valve-sparing root repairs). The unilateral cerebral perfusion (mean duration 23.3±17.2; range, 6-105 minutes) was carried out through a cannulated common carotid or innominate artery, with a pressure-controlled (70-100 mm Hg) flow (mean flow, 1.4±0.3 L/min; mean pressure, 90.1±20.1 mm Hg) and a constant blood temperature of 28°C to ensure the patency of collateral pathways.
At a rectal temperature of 31.2±1.8°C, the circulatory stoppage of the lower body was conducted (mean duration 18.4±9.9 minutes) by researchers. The incidences of permanent neurological deficiency and temporary neurological dysfunctions were 1.0 % and 4.9 %, respectively, in the early (30-day) and in-hospital periods. Under aortic arch surgery, unilateral cerebral perfusion conducted in the stated settings is highly successful for cerebral protection.
Reference:www.jtcvs.org/article/S0022-5223(19)30473-8/fulltext
