AN ASSESSMENT OF SELECTIVE CEREBRAL PERFUSION VIA THE INNOMINATE-ARTERY IN AORTIC-ARCH REPLACEMENT

Maintaining an adequate cerebral oxygen supply is a serious problem in aortic arch surgery. Deep hypothermic circulatory arrest is the most common method used for cerebral protection, but guarantees only a time -limited safety period. Based on experimental investigations, we appli ed selective cerebral perfusion via the innominate artery alone with o nly moderate hypothermia (28 degrees C) and without circulatory arrest in 25 consecutive patients undergoing surgical treatment of an aneury sm (n = 10) or acute type-A dissection (n = 15) involving the aortic v alve and arch. In every case a test perfusion was carried out to asses s whether the cerebral perfusion achieved would be adequate for the wh ole operation. In no case was the perfusion inadequate. As a new perio perative monitoring system, we used computer-aided topographical elect roencephalometry (CATEEM). There were 18 male and 7 female patients, t heir age was 47.0 +/- 15.1 years (mean +/- SD). Mean time periods were 155.1 +/- 37.3 min for aortic cross-clamping, and 69.3 +/- 35 min for selective cerebral perfusion. Postoperatively, two patients (8%) reve aled a temporary left-sided hemiparesis, and 4 patients (16%) died wit hin 30 days. The overall mortality rate was 16% in a follow-up period of 24.2 +/- 9.5 months. In this small group the CATEEM monitoring enab led an intraoperative selection of patients with sufficient bihemisphe ric collateral circulation and therefore suitable for simple innominat e artery perfusion.