SYSTEMIC HYPOTHERMIA AND CIRCULATORY ARREST COMBINED WITH ARTERIAL PERFUSION OF THE SUPERIOR VENA-CAVA - EFFECTIVE INTRAOPERATIVE CEREBRAL PROTECTION

We have used retrograde arterial perfusion of the superior vena cava a s an adjunct to deep hypothermia and systemic circulatory arrest for i ntraoperative cerebral protection in 43 adult patients (18 of whom wer e 70 years old or older), The indications for the use of circulatory a rrest were thoracic aortic operations (37 patients) and atherosclerosi s or calcification of the ascending aorta (6 patients) in patients nee ding aortic valve or coronary operations, In all patients systemic hyp othermia (16 degrees to 18 degrees C) was achieved with cardiopulmonar y bypass and the systemic arterial circulation was arrested, Retrograd e arterial perfusion of the superior vena cava was established through a wire-reinforced venous cannula (with a superior vena cava tournique t) at a temperature of 15 degrees C, In 36 patients a separate roller pump system was used for the retrograde cerebral perfusion, Central ve nous pressure was monitored at 25 to 30 mm Hg; mean flow rate was 250 ml/min. Periods of circulatory arrest and retrograde cerebral perfusio n ranged from 4 to 110 minutes (mean 58 minutes), and for seven patien ts the period of circulatory arrest was longer than 60 minutes, Four p ostoperative deaths occurred, one related to stroke in a patient who h ad an aortic dissection during coronary surgery and the others related to noncerebral complications. Three nonfatal cerebral complications o ccurred, although all had completely resolved by late follow-up, Advan tages of retrograde cerebral perfusion are (1) simplicity of use and a voidance of vascular trauma, (2) excellent exposure, (3) retrograde fl ow that minimizes embolization of air and atherosclerotic debris, and (4) effective cerebral oxygen delivery, Retrograde cerebral perfusion appears to be an important adjunct to hypothermia and circulatory arre st not only for patients undergoing operation for ascending aorta and aortic arch disease but also for patients with diffuse aortic atherosc lerosis undergoing coronary or valve operations.