Two different techniques of retrograde cerebral perfusion for thoracic aortic surgery through a left thoracotomy

The authors used profound hypothermic circulatory arrest and continuous ret rograde cerebral perfusion for aortic surgery that involved the distal arch through a left thoracotomy. For the first seven patients, oxygenated blood from cardiopulmonary bypass was perfused retrogradely through a venous can nula positioned into the right atrium, In the last 11 cases, venous blood, provided by a perfusion from the lower body, was circulated passively in th e brain with the descending aorta clamped. The period of profound hypotherm ic circulatory arrest was 34.6 +/- 11.1 min, and continuous retrograde cere bral perfusion was 31.3 +/- 11.1 min. Seventeen patients survived, but ther e was one early death. Two patients with a severely atherosclerotic aneurys m developed permanent neurological dysfunction, The combination of profound hypothermic circulatory arrest, continuous retrograde cerebral perfusion a nd open aortic anastomosis through a left thoracotomy protects the brain ad equately, and facilitates evacuation of debris and air in the aortic arch. It produces satisfactory results for aortic surgery that involves the dista l arch. (C) 2000 The International Society for Cardiovascular Surgery. Publ ished by Elsevier Science Ltd. All rights reserved.