BRAIN PROTECTION VIA CEREBRAL RETROGRADE PERFUSION DURING AORTIC-ARCHANEURYSM REPAIR

Eleven patients underwent resection and graft replacement of ascending and aortic arch aneurysms. Retrograde cerebral perfusion was used dur ing the procedures to minimize cerebral ischemia. Retrograde cerebral perfusion (15-degrees to 24-degrees-C) was administered through the su perior vena cava. The mean cerebral ischemic time was 35 minutes (rang e, 11 to 71 minutes). Throughout retrograde cerebral perfusion, blood samples were drawn from the innominate and left carotid arteries at 1, 5, and every 10 minutes thereafter for analysis of arterial oxygen co ntent, total creatine kinase level, and creatine kinase BB fraction. A ll patients survived. All except 1 awoke neurologically intact. In thi s patient, electroencephalogram and transcranial Doppler studies condu cted before circulatory arrest were consistent with embolic phenomena. There was no significant difference between the current group's intra operative electroencephalograms and those of a similar historical grou p. Postoperative complications included transient renal failure, myast henia gravis, cholecystitis, premature atrial contractions, atrial fib rillation, and vocal cord paralysis. The creatine kinase BB fraction r ange was 1.8 to 13.4. The increase of total creatine kinase level was due to MM fraction. Retrograde cerebral perfusion during circulatory a rrest is a valuable adjunct for protecting the brain. The creatine kin ase BB band was not a good marker to detect brain injury. With continu ed use of this technique and accumulation of a larger series, we may b etter define the role of retrograde cerebral perfusion in brain protec tion.