Simplified cerebral protection using unilateral antegrade cerebral perfusion and moderate hypothermic circulatory arrest.

Background: Antegrade cerebral perfusion is one of the most reliable methods of organ protection during hypothermic circulatory arrest for aortic arch surgery. We used a simplified antegrade cerebral perfusion technique with low mortality and morbidity.

Methods: Between January 2005 and August 2008, 21 patients underwent aortic arch surgery with unilateral antegrade selective cerebral perfusion through the brachiocephalic artery and moderate hypothermic circulatory arrest. The mean age for patients was 58.0+/-11.1 (27-82) years. Cardiopulmonary bypass was commenced and the ascending aorta was cross-clamped. Patients were cooled to 22-28 degrees C, whilst the proximal anastomosis was performed. The brachiochephalic artery was cannulated using a balloon tipped 15Fr catheter used for retrograde cardioplegia. Antegrade cerebral perfusion was established at the rate of 10 ml//kg/min. The perfusion pressure was controlled between 50 and 70 mm Hg whilst the distal anastomosis was completed.

Results: There were no operative deaths and no permanent neurological deficits. Four patients had temporary confusion. Mean antegrade cerebral perfusion time was 21.6+/-8.0 (12-48)min. Eight out of 20 patients had circulatory arrest at 28 degrees C and their mean circulatory arrest time was 22.8+/-4.7 (16-32)min.

Conclusions: The mortality and neurological outcomes of aortic surgery using unilateral antegrade cerebral perfusion with moderate hypothermic circulatory arrest produced satisfactory results. Bilateral cannulation and deep hypothermia appear to be unnecessary in most cases. The coagulopathy from deep hypothermia is thereby avoided.