17. Retrograde Cerebral Perfusion: A Valuable Adjunct During Circulatory Arrest

Joseph S. Coselli, Scott A. LeMaire, Jose Pagan

Baylor College of Medicine/The Methodist Hospital

Houston, Texas

Purpose: Cardiopulomonary bypass with hypothermic circulatory arrest remains the mainstay for cerebral protection in the treatment of aneurysmal disease of the transverse aortic arch. Reversed cerebral perfusion (RCP) via the superior vena caval cannula during circulatory arrest has evolved as an adjuvant to cerebral protection.

Methods: Between Jan. 13, 1987, and March 17, 1998, 571 patients underwent circulatory arrest for treatment of proximal aortic pathology. 267 patients (48.8 percent) were treated for acute or chronic dissection. 335 patients (58.7 percent) were treated using RCP and 236 (41.3 percent) were treated with RCP>

Results: In those with RCP, the 30-day mortality was 4.8 percent (16 patients) and in those without RCP, 12.7 percent (30 patients). In patients treated with RCP, the stroke rate was 2.7 percent (nine patients) and without RCP 5.5 percent (13 patients). The variables associated with early mortality in those patients with RCP were preoperative CORPD, circulatory arrest time, pump time, cardiac complications and stroke; p<0.05.

Conclusion: Although the theoretical advantages to RCP including homogenous cooling of the brain and the delivery of metabolic substrates during circulatory arrest will require additional evaluation, the practical advantage of reduced risk of thromboembolic and air embolism as a source of stroke are confirmed in this retrospective clinical evaluation.