Abstract
To evaluate the results of a technique described by Carreira et al. using bilateral antegrade selective cerebral perfusion by isolating the brachiocephalic trunk and the left carotid artery. Fifteen patients were operated between June 2005 and September 2007. Data analysis were performed using Epi Info and statistical significance was set at p<0.05. Of the 15 patients, 53.3% were male; mean age was 59.86+/-15.4 years; 60% presented with type A acute aortic dissection; 6.7% type B; and 33.3% aneurysm of aorta and arch. Mean CPB and aortic clamping time was 177.6+/-39.4 and 135.9+/-34.0 minutes, respectively. In this group, 86.7% were not submitted to total circulatory arrest, with mean unilateral and bilateral selective cerebral perfusion time of 10.9+/-2.0 and 57.2+/-21.2 minutes, respectively. Mean hypothermic temperature was 23.0+/-2.9 masculineC. Two had left subclavian artery ligature, 60% used separated aortic grafts, and four used aortic endoprosthesis. Three (20%) patients died, all of them in the acute aortic dissection group. There were no neurological complications. The mean follow up time was 11.7+/-9.6 months. Regarding mortality, none of the parameters were statistically significant (p>0.05). The technique of bilateral selective cerebral perfusion described by Carreira et al. can be performed by others and presents similar results to the international literature. The excellent neurological outcome and easy bleeding control on surgical sutures lines are the major advantages of this new procedure.
Highlights
Surgeries involving the aortic arch still present high rates of hemorrhagic and neurologic complications
The technique of bilateral selective cerebral perfusion described by Carreira et al can be performed by others and presents similar results to the international literature
Safi et al [13] demonstrated that the use of deep hypothermia with total circulatory arrest has a protective effect against stroke (3) if compared with no deep hypothermia with total circulatory arrest (9%)
Summary
Surgeries involving the aortic arch still present high rates of hemorrhagic and neurologic complications. Several techniques, including deep hypothermia with total circulatory arrest (DHTCA) [2,3,4], unilateral or bilateral selective antegrade cerebral perfusion (SACP) [5,6,7], and retrograde cerebral perfusion (RCP) through superior vena cava [8,9,10] have been used to protect the central nervous system. Each one of these techniques presents advantages and disadvantages and their different cannulation forms have recently been revised by Dias et al [11]. Safi et al [13] demonstrated that the use of deep hypothermia with total circulatory arrest has a protective effect against stroke (3) if compared with no deep hypothermia with total circulatory arrest (9%)
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