RETROGRADE CEREBRAL PERFUSION FOR AORTIC-ARCH OPERATION

Deep hypothermic retrograde cerebral perfusion (RCP) has recently been the focus of interest as a simple new technique of brain protection d uring the operation for thoracic aneurysms. During the period from Jan uary 1991 to July 1994, 21 consecutive patients underwent operations o n the various portions of the thoracic aorta with the use of deep hypo thermic RCP. There were 10 men and 11 women, ages ranging from twenty- eight to seventy-eight (mean 61.4) years old. There were 9 cases with true aortic aneurysm, and 12 with dissecting aneurysm. In 8 patients ( 38.1%) the procedures were done on an emergency basis for ruptured/imp ending ruptured aneurysms or acute dissecting aneurysms. Four patients died before the adequate assessment of their neurologic function. One patient had a cerebral infarction probably due to dissection of the l eft common carotid artery. The remaining 16 patients showed clear cons ciousness and had no serious neurologic complications postoperatively. Total perfusion time averaged 297 +/- 110 minutes (ranging from 162 t o 548 minutes). Rectal temperatures were 20.1 +/- 1.4 degrees C (rangi ng from 18.0 to 22.5 degrees C). RCP time averaged 51.3 +/- 13.9 minut es (ranging from twenty-seven to eighty minutes). Blood gas analysis o f the returned blood sampled from the left common carotid artery or th e innominate artery and the ophthalmoscopic findings demonstrated the insufficiency of blood and oxygen supply to the brain during RCP. Ther efore, RCP time should be shortened and pharmacologic cerebral protect ion is recommended to reduce neurologic complications during operation s on the thoracic aorta using RCP.