A newly developed cerebral perfusion catheter for aortic arch operation

Abstract

The object of this study was to develop a better catheter for selective cerebral perfusion during aortic arch operation. Flow through the catheter was evaluated in an in vitro study under 40 mmHg pressure at 25°C using 40% glycerin when the catheter was straight or right-angled with either a gentle or a sharp curve. Two catheters of 14, 16, or 18 French were connected with a Y-shaped tube, and the flow through each catheter was tested in the same way when the catheters were straight or right-angled. Moreover, we evaluated the operative outcome using this new catheter in 38 patients who underwent total arch replacement. The correlation between right radial artery pressure and catheter tip pressure was examined in 17 of these 38 patients. The difference in oxygenation between the right and left hemispheres was also exmained by two-channel nearinfrared spectroscopy. The results showed that flow through the catheter was almost identical, regardless of the type of its configuration. When two catheters of different sizes were connected with a Y-shaped tube, the total flow and flow ratio between the two catheters were also similar in both the straight and the right-angled configuration. As regards the clinical outcome, there were no in-hospital deaths, no permanent neurological dysfunction, and one temporary neurological dysfunction. Dissociations between right radial artery pressure and catheter tip pressure were seen in 3 of the 17 patients. No difference in oxygenation between the two hemispheres was found. We conclude that the new catheter provided an uncluttered operative field and may contribute to improved surgical results.