Arch repair with unilateral antegrade cerebral perfusion

Abstract

Arch repair with antegrade cerebral perfusion through right brachial artery has excellent neurological results, provides technical simplicity and optimal repair without time restraints, does not necessitate deep hypothermia and requires shorter CPB and operation times.

Advantages of upper brachial artery cannulation in aortic surgery

“…1,3 The vascular complication rates involving the brachial artery were 0.5% and 0.9%, respectively, in these studies. 1,3 In this study, the local neurologic complication rate was 4.5%, and there was no vascular complication (Table 4).…”

“…2 ACP does not necessitate deep hypothermia. 3 The cerebral oxygen consumption decreases by 50%-60% of baseline at a core temperature of 25 C-28 C, and further cooling does not provide the same decrease in brain oxygen consumption. 4 Although Tasdemir and colleagues 1 and Kucuker and colleagues 3 did not report neurological or organ malperfusion problems when they used a CPB flow rate of 4.5 LÁmin À1 in patients with large body surface areas, we prefer cooling (28 C) quickly after establishing CPB, and placing the aortic crossclamp as early as possible, to avoid neurological and organ damage.…”

Unilateral cerebral perfusion: right versus left

“…After the development of the techniques of arch arteries cannulation, the unilateral cerebral perfusion underwent a renaissance. Recently, many experimental and clinical series documented the usefulness of unilateral perfusion for brain protection [4][5][6][7][18][19][20].…”

Visceral protection during moderately hypothermic selective antegrade cerebral perfusion through right brachial artery

“…We have been using selective ACP through right brachial artery cannulation with moderate hypothermia in aortic arch operations since 1996. Our institution described a unilateral ACP technique through the right brachial artery, in conjunction with moderate hypothermia (26-28 8C) with excellent neurological outcome [1][2][3]. The cannulation of the right brachial artery ensures continuous ACP while avoiding manipulation of the brachiocephalic vessels, which are often atherosclerotic or dissected, provides with a free operative field and eliminates the need to switch cannulation site following arch replacement.…”

“…Routinely using this technique since 1996, our institution demonstrated the safety of this technique in terms of surgical outcome, cerebrovascular complications and neurocognitive tests [1][2][3][4]. However, the issue of distal organ protection with the use of this technique remained to be clarified.…”