A Cardiopulmonary Bypass Perfusion Technique for the Surgical Repair of Aortic Type I Dissections Requiring the Elephant Trunk Procedure

Abstract

The effect of cerebral and spinal cord protection by a modified perfusion technique during the elephant trunk procedure was assessed. Between 1997 and 1998, six patients underwent selective cerebral perfusion (SCP) and lower half of the body perfusion (LBP), in which the right subclavian and left femoral arteries were separately cannulated and perfused by individual pump heads. Moderate systemic cooling was used (nasal temp. 20–30°C; rectal temp. 23–26°C). The open distal aortic repair was performed using only the selective cerebral perfusion; while the aortic arch reconstruction was performed using both selective cerebral and lower half of the body simultaneous perfusion. Blood oxygen saturation of the left jugular vein (SjO2) and regional oxygen saturation cerebral (rSO2) in the front region of the brain, was monitored along with the pressure of the left temporal superficial and femoral artery. The mean cardiopulmonary bypass time was 136 minutes, with a mean arrest time of 92 minutes. Mean duration of isolated selective cerebral perfusion was 23 minutes, with flow rates of 5–8 mL/kg/min; a left temporal superficial artery pressure of 50 mmHg; SjO2 65–80%, and rSO2 58–72%. Mean duration of simultaneous selective cerebral and lower half of the body perfusion was 27 minutes; cerebral flow rates 5–8 mL/kg/min; the left temporal superficial artery pressure of 45–50 mmHg; SjO2 70–85% and rSO2 55–76%. At the same time, lower half of the body flow rates were maintained within 30–50 mL/kg/min; with a femoral artery pressure 50–80 mmHg. Mean extubation time was 28 hours; mean ICU time was 4.5 days. There were no neurologic complications in any patient. All patients survived the operation and were discharged from the hospital. This modified perfusion technique of SCP and LBP worked well and provided satisfactory cerebral and spinal cord protection.