SURGICAL-TREATMENT OF ACUTE AORTIC DISSEC TION WITH BRAIN PROTECTION VIA CEREBRAL RETROGRADE PERFUSION

Four consecutive patients underwent resection and graft replacement of ascending aorta or aortic arch for acute dissection. Retrograde cereb ral perfusion (RCP) was used during circulatory arrest. RCP at 15 degr ees C was administered through the superior vena cava. Duration of cer ebral ischaemia and cardiopulmonary bypass averaged 33 and 156 minutes respectively. Retrograde perfusion flow was regulated from 100 to 800 ml/minute to maintain an internal jugular vein pressure of about 25 c m H2O. All patients survived. Three patients awoke neurologically inta ct. Minor neurological disturbance was found in 1 patient, he was disc harged from hospital at day 11 without any detectable neurological def icit. This technique was attractive because it provided a dry operativ e field unencumbered by perfusion cannulas or clamps, facilitated cons truction of a more secure distal anastomosis, and avoided the risk of further injury resulting from the aortic cross clamp. It seems that RC P allows longer circulatory arrest time.