RETROGRADE CEREBRAL PERFUSION DURING CIRC ULATORY ARREST WITH PROFOUND HYPOTHERMIA

Between May 1993 and August 1994, 15 patients (10 men) with type A aor tic dissection (9 acute) had a replacement of the ascending aorta and/ or aortic arch with circulatory arrest with profound hypothermia and r etrograde cerebral perfusion. Mean circulatory arrest time was 47.5 mi n (range 23 to 68 min). Three patients (20%) died in relation to posto perative bleeding. No patient had a new neurologic damage related to s urgery. Ten patients were awake and oriented before 24 hours of the op eration and another one before 48 hours; 4 patients required more than 48 hours to be completely awake and oriented. Two patients were opera ted on with a recent stroke. One of them recovered without sequelae be fore hospital discharge and the other one had a major regression of hi s brain damage. Two other patients had emergency surgery because of ca rdiac tamponade and cardiogenic shock. Both of them had a satisfactory recovery. Six patients presented azotemia but only 2 of them needed d ialysis. There was no case of Q wave infarction nor congestive heart f ailure in the perioperative period. Follow-up was 100% completed (12 p atients) with a mean of 9.8 months (range 5 to 18 months). One patient died on the 10th postoperative month because of a late infectious pro cess. Eight patients are in functional class I and 3 in II. Ten of the m are back to their usual activities. Although retrograde cerebral per fusion is a new surgical technique, it seems to be a very valuable com plement for brain protection in ascending aorta and/or aortic arch sur gery with circulatory arrest with profound hypothermia.