RETROGRADE CEREBRAL-CIRCULATION FOR DISTAL AORTIC-ARCH SURGERY THROUGH A LEFT THORACOTOMY

We have devised a simple hypothermic retrograde cerebral circulation t echnique for protecting the brain during aortic arch surgery. The cent ral venous pressure is simply elevated (15 to 18 mmHg) while the aorti c arch is open and the descending aorta occluded, causing oxygen-satur ated venous blood from the lower half of the body, which is undergoing deep hypothermic (15-degrees-C to 1-degrees-C) perfusion, to circulat e in the brain in a retrograde fashion, supplying it with oxygen. Twen ty-six cases of distal aortic arch aneurysm treated using this method, through a left thoracotomy with femoral vein cannulation, were evalua ted. Retrograde cerebral circulation time was 59.6 +/- 13.1 minutes (4 0 to 93 min). Retrograde flow was 43.9 +/- 13.0 (25 to 62) mL/min. Sig nificant oxygen and apparent lactate extraction were noted in the brai n. Early death resulted in 3 of the first 14 cases (21.4%) from emboli sm, and in 1 of the other 12 cases (8.3%) from massive bleeding and mu ltiple organ failure. Only one late death occurred. No death was attri buted to the method itself. This method, with its simplified operative procedure using a lateral thoracotomy, supplied oxygen to the brain a nd protected it during interruption of the cerebral circulation. Caref ul management of the atherosclerotic aorta is needed.