Nygammal metod minskar neurologisk risk vid arcus aortae-kirurgi. Selektiv antegrad hjärnperfusion ger bra skydd, visar retrospektiv studie

Abstract

nnominate artery and left carotid artery cannulation for antegrade brain perfusion allows accurate bilateral pressure-controlled brain perfusion. The aim of this study was to evaluate the incidence of adverse neurological events and 90-day mortality in 40 consecutive patients undergoing elective aortic arch repair using this technique. Forty consecutive patients underwent elective aortic arch repair using selective antegrade brain perfusion. The perfusion was instituted by cannulation of the innominate artery (using standard cannulae) and by direct cannulation of the left common carotid artery (using cannulae having a built-in-side arm for pressure monitoring). Bilateral radial artery and left common carotid artery pressure monitoring allowed precise, pressure-controlled bilateral brain perfusion. Bilateral selective antegrade brain perfusion was given with a perfusion rate of 4.6 ml to 15.9 ml/kg/min (mean 9.6 ml/kg/min). This was sufficient to obtain dual-controlled mean cerebral perfusion pressures of 50-70 mmHg as monitored simultaneously in the right radial artery and the left carotid artery. The incidence of stroke and transient neurological dysfunction was 2.5 % each. Ninety-day mortality was 2.5 %. Pressure-controlled, bilateral, selective antegrade brain perfusion by innominate artery cannulation seems to be a safe method for cerebral protection during elective aortic arch repair