An Assessment of Selective Cerebral Perfusion Via the Innominate Artery in Aortic Arch Replacement

Abstract

Maintaining an adequate cerebral oxygen supply is a serious problem in aortic arch surgery. Deep hypothermic circulatory arrest is the most common method used for cerebral protection, but guarantees only a time-limited safety period. Based on experimental investigations, we applied selective cerebral perfusion via the innominate artery alone with only moderate hypothermia (28°C) and without circulatory arrest in 25 consecutive patients undergoing surgical treatment of an aneurysm(n = 10) or acute type-A dissection (n = 15) involving the aortic valve and arch. In every case a test perfusion was carried out to assess whether the cerebral perfusion achieved would be adequate for the whole Operation. In no case was the perfusion inadequate. As a new perioperative monitoring System, we used computer-aided topographical electroencephalometry (CATEEM).There were 18 male and 7 female patients, their age was 47.0 ± 15.1 years (mean ± SD). Mean time periods were 155.1 ± 37.3 min for aortic cross-clamping, and 69.3 ± 35 min for selective cerebral perfusion. Postoperatively, two patients (8%) revealed a temporary left-sided hemiparesis, and 4 patients (16 %) died within 30 days. The overall mortality rate was 16% in a follow-up period of 24.2 ± 9.5 months. In this small group the CATEEM monitoring enabled an intraoperative selection of patients with sufficient bihemispheric collateral circulation and therefore suitable for simple innominate artery perfusion.

Key words

Selective cerebral perfusion - Innominate artery - Aortic arch surgery - Computer-aided topographical electroencephalometry