An adjunct to cerebral protection during circulatory arrest

Abstract

For surgery of dissecting ascending aortic aneurysms we have employed deep hypothermic circulatory arrest to permit construction of the distal aortic anastomosis in a bloodless field. The cerebral complications of circulatory arrest in deep hypothermia are well recognised. Many methods of cerebral protection have been suggested besides deep hypothermia including retrograde cerebral perfusion, administration of thiopentone and cerebroplegia. We report a supplementary technique that theoretically may provide improved cerebral protection, and present the results in four cases.

Protective Effect of Continuous Retrograde Cerebral Perfusion on the Brain During Deep Hypothermic Systemic Circulatory Arrest

“…There have been reports of series of cases in which the aortic arch was replaced under continuous retrograde cerebral perfusion with excellent results.16. [23][24][25][26][27][28][29][30] The overall mortality rate of 12% observed in our patients compares favorably with that in other similar series. We are convinced that continuous retrograde cerebral perfusion was not the cause contributing to death in our 4 patients.…”

Acute thermal injury associated with cerebral protection in the surgical management of aortic dissection

“…In our centre we have employed deep hypothermic circulatory arrest to permit construction of the distal anastomosis in a bloodless surgical field, with retrograde cerebral perfusion employed as an additional means of cerebral protection. As an adjunct we have also routinely packed the head in ice as described by Steyn et al 1…”