Antegrade Selective Cerebral Perfusion - How to Proceed?

Abstract

Aortic surgery still carries a high risk of brain damage that dominates postoperative morbiditiy and mortality. The concept and advantages of antegrade selective cerebral perfusion, which allows for numerous variations in its implementation, have been clearly seen for more than a decade now, but the preferred way of positioning remains unanswered. Ideal perfusion during ascending aorta/arch surgery should allow the easy implementation of selective antegrade cerebral perfusion while avoiding atheroembolization or false lumen perfusion during dissections.

Selective cerebral perfusion - cannulation site - neuroprotection - aortic surgery

References

• 1 Frist W H, Baldwin J C, Starnes V A, Stinson E B, Oyer P E, Miller D C, Jamieson S W, Mitchell R S, Shumway N E. A reconsideration of cerebral perfusion in aortic arch replacement.  Ann Thorac Surg. 1986;  42 273-281
• 2 Strauch J T, Spielvogel D, Haldenwang P L, Zhang N, Weisz D, Bodian C A, Griepp R B. Impact of hypothermic selective cerebral perfusion compared with hypothermic cardiopulmonary bypass on cerebral hemodynamics and metabolism.  Eur J Cardiothorac Surg. 2003;  24 807-816
• 3 Sabik J F, Lytle B W, McCarthy P M, Cosgrove D M. Axillary artery: an alternative site of arterial cannulation for patients with extensive aortic and peripheral vascular disease.  J Thorac Cardiovasc Surg. 1995;  109 885-891
• 4 Baribeau Y R, Westbrook B M, Charlesworth D C, Maloney C T. Arterial inflow via an axillary artery graft for the severely atheromatous aorta.  Ann Thorac Surg. 1998;  66 33-37
• 5 Bachet J, Guilmet D, Goudot B, Dreyfus G D, Delentdecker P, Brodaty D, Dubois C. Antegrade cerebral perfusion with cold blood: a 13-years experience.  Ann Thorac Surg. 1999;  67 1874-1878 1891-1894 (discussion
• 6 Kazui T, Kimura N, Yamada O, Komatsu S. Surgical outcome of aortic arch aneurysms using selective cerebral perfusion.  Ann Thorac Surg. 1994;  57 904-911
• 7 Dossche K M, Schepens M AAM, Morshuis W J, Muysoms F E, Langemeijer J J, Vermeulen F E. Antegrade selective cerebral perfusion in operations on the proximal thoracic aorta.  Ann Thorac Surg. 1999;  67 1904-1910
• 8 Di Bartolomeo R, Pacini D, Di Eusanio M, Pierangeli A. Antegrade selective cerebral perfusion during operations on the thoracic aorta: our experience.  Ann Thorac Surg. 2000;  70 10-16
• 9 Kazui T, Washiyama N, Muhammad B A, Terada H, Yamashita K, Takinami M, Tamiya Y. Total arch replacement using aortic arch branched grafts with the aid of antegrade selective cerebral perfusion.  Ann Thorac Surg. 2000;  70 3-8
• 10 Ando M, Nakajima N, Adachi S, Nakaya M, Kawashima Y. Simultaneous graft replacement of the ascending aorta and total aortic arch for type A aortic dissection.  Ann Thorac Surg. 1994;  57 669-676
• 11 Strauch J T, Spielvogel D, Lauten A, Lansman S L, McMurtry K, Bodian C A, Griepp R B. Axillary artery cannulation: Routine use in ascending and aortic arch replacement.  Ann Thorac Surg. 2004;  78 103-108
• 12 Numata S, Ogino H, Sasaki H, Hanafusa Y, Hirata M, Ando M, Kitamura S. Total arch replacement using antegrade selective cerebral perfusion with right axillary perfusion.  Eur J Cardio Thorac Surg. 2003;  23 771-775
• 13 Spielvogel D, Strauch J T, Minanov O P, Lansman S L, Griepp R B. Aortic arch replacement using a trifurcated graft and selective cerebral antegrade perfusion.  Ann Thorac Surg. 2002;  74 S1810-S1814
• 14 Mazzola A, Gregorini R, Villani C, DiEusanio M. Antegrade cerebral perfusion by axillary artery and left carotid artery inflow at moderate hypothermia.  Eur J Cardiothorac Surg. 2002;  21 930-931
• 15 Shimazaki Y, Watanabe T, Takahashi T, Minowa T, Inui K, Uchida T, Koshika M, Takeda F. Minimized mortality and neurological complications in surgery for chronic arch aneurysm. Axillary artery cannulation, selective cerebral perfusion and replacement of the ascending and total arch aorta.  J Card Surg. 2004;  19 338-342
• 16 Svensson L G. Antegrade perfusion during suspended animation?.  J Thorac Cardiovasc Surg. 2002;  124 1068-1070
• 17 Tasdemir O, Saritas A, Kücüker S, Özatik M A, Sener E. Aortic arch repair with right brachial artery perfusion.  Ann Thorac Surg. 2002;  73 1837-1842
• 18 Di Eusanio M, Wesselink R M, Morshuis W J, Dossche K M, Schepens M AAM. Deep hypothermic circulatory arrest and antegrade selective cerebral perfusion during ascending aorta-hemiarch replacement: A retrospective comparative study.  J Thorac Cardiovasc Surg. 2003;  125 849-854
• 19 Mochzuki Y, Iida H, Mori H, Yamada Y, Miyoshi S. Left common carotid artery cannulation for type A aortic dissections.  Tex Heart Inst J. 2003;  30 128-129
• 20 Neri E, Massetti M, Barabesi L, Pula G, Tassi R, Toscano T, Tucci E, Benvenuti A, Capannini G, Miraldi F, Sassi C. Extrathoracic cannulation of the left common carotid artery in thoracic aorta operations through a left thoracotomy: Preliminary experience in 26 patients.  J Thorac Cardiovasc Surg. 2002;  123 901-910