CEREBRAL PROTECTION BY SELECTIVE CEREBRAL PERFUSION DURING SURGERY OFTHE TRANSVERSE AORTIC-ARCH

The aim of this study was to evaluate the technique of cerebral protec tion by selective cerebral perfusion with moderate hypothermia during surgery of the transverse aortic arch. Twenty-three patients were oper ated for partial or total replacement of the transverse aortic arch be tween January 1987 and December 1993 by the technique of selective cer ebral perfusion by bilateral carotid cannulation. There were 12 cases of aneurysm of the ascending aorta and/or transverse aortic arch, one aneurysm of the innominate artery and 10 Stanford type A aortic dissec tions. The selective cerebral flow rate was 1-1.5 l/min: the perfusion pressure 60-80 mmHg and the temperature of cerebral perfusion 25-28 d egrees C. The perioperative mortality was 13 %; the causes of death we re not neurological (3 haemorrhages). The neurological morbidity was 1 0 % (one brachial monoparesis and one bulbar tetraparesis). This is th erefore a useful technique of cerebral protection which avoids the com plications of deep hypothermia with circulatory arrest and does not li mit the time of aortic repair.