Clinical application of total body retrograde perfusion to operation for aortic dissection

Yasuura, K; Ogawa, Yutaka; Okamoto, Hiroshi; Asakura, T; Hoshino, M; Sawazaki, Masaru; Matsuura, Akio; Maseki, T; Abe, Toshio

doi:10.1016/0003-4975(92)90328-2

Cited by 40 publications

(9 citation statements)

References 5 publications

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“…45 Additional retrograde perfusion of the whole body has also been used in an attempt to preserve the spinal cord and distal organs during operations on the arch and on the thoracic aorta. 46 The value of retrograde cerebral perfusion in the treatment of air embolism was pointed out by Mills and Ochsner in 1980,39 and more recently by others47 with regard to operations on the aortic arch. So far, the published results with this method do not allow clear separation of its clinical effects from that of deep hypothermia and circulatory arrest alone.…”

Section: Retrograde Cerebral Perfusionmentioning

confidence: 93%

Hypothermic Circulatory Arrest and Other Methods of Cerebral Protection During Operations on the Thoracic Aorta

et al. 1994

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Current surgical techniques in operations on the thoracic aorta frequently require exclusion of the cerebral circulation for varying periods. During these periods, hypothermic circulatory arrest (HCA), selective cerebral perfusion (SCP), and retrograde cerebral perfusion (RCP) can be used for cerebral protection. Hypothermia is the principle component of these methods of protection. The main protective effect of hypothermia is based on reduction of cerebral energy expenditures and largely depends on adequate suppression of cerebral function. It is most effective at deep hypothermic levels (13 degrees C to 15 degrees C). Measures that preserve autoregulation of cerebral blood flow help increase the margin of safety with all methods of protection. There is solid experimental and clinical data indicating the safe limits and outcome following HCA. Current applications of SCP and RCP are fairly recent developments and do not have comparable supporting data. SCP can be used without deep hypothermia and allows prolonged periods of cerebral protection, but is complex in application. RCP is simpler, but always requires deep hypothermia. Present clinical data do not allow separation of its protective effect from that of HCA alone. Recent modifications in the application of HCA include monitoring of cerebral O2 extraction, and selective use of supplemental SCP to limit arrest times to less than 50 minutes, or RCP to prevent embolic strokes, as indicated. These changes appear to have reduced the overall mortality, the severity of embolic strokes, and stroke-related mortality.

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Section: Retrograde Cerebral Perfusionmentioning

confidence: 93%

Hypothermic Circulatory Arrest and Other Methods of Cerebral Protection During Operations on the Thoracic Aorta

et al. 1994

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“…Conversely, Yasuura et al reported that no neurological disorder developed in a patient subjected to 147 min of RCP. 10 Other reports have also stated that no serious brain damage occurred despite 100 min or more of RCP; 2,7,10 however, Aomi and colleagues reported that a RCP time of longer than 80 min induced transient consciousness disturbance in 57% of their patients and proposed that the safe time limit was 80 min or less. 7,8 Based on the findings of the present and previous studies, we believe that if RCP is carried out under optimal conditions, including the perfusion pressure and brain temperature, the marginal duration of safe RCP without major neurological complications may be extended to around 90 min.…”

Section: Discussionmentioning

confidence: 96%

“…Brain metabolism decreases exponentially with reductions in temperature, and hypothermia preserves cellular stores of high energy phosphate. 9 According to many clinical reports, the rectal temperature during RCP is maintained at around 15°-20°C, 1,4,7,10 and the nasopharyngeal or pharyngeal temperature is maintained at around 10°-20°C. 1,2,4,11 In the present study, only the minimum rectal temperature correlated with the time required for the patient to regain consciousness, with a lower rectal temperature resulting in a more rapid emergence from anesthesia.…”

Section: Discussionmentioning

confidence: 99%

Postoperative brain complications following retrograde cerebral perfusion

et al. 1999

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This study was undertaken to investigate the neurological risk factors associated with the retrograde cerebral perfusion (RCP) technique, by examining the relationship between intraoperative parameters and post-operative brain complications. A total of 12 patients who underwent surgery for thoracic aortic aneurysms using the RCP technique were included in this study. Profound hypothermia was induced through cardiopulmonary bypass which was established with a femoral arterial cannula and bicaval return. During RCP, a venous drainage cannula from the superior vena cava (SVC) was switched over to the arterial return circuit, and oxygenated blood was retrogradely infused through the SVC. The perfusion flow rate was maintained at 273 +/- 113 ml/min and the SVC pressure was maintained at 15 +/- 6 mmHg. The RCP time was 68 +/- 27 min with a range of 27-130 min, and the lowest rectal temperature was 16 +/- 1 degrees C. The total elapsed time until emergence from anesthesia after the operation was 12 +/- 6 h. The operation time correlated with the awakening time (r = 0.729, P = 0.0088). Longer RCP times of up to 101 and 130 min tended to result in post-operative brain damage. The lowest rectal temperature also correlated with the awakening time (r = 0.697, P = 0.0149), and an inverse correlation between the SVC pressure and the awakening time was observed (r = -0. 727, P = 0.0091). These findings demonstrate the importance of reducing both the RCP and operation times to decrease the incidence of brain damage. If carried out under optimal conditions, including perfusion pressure and brain temperature, RCP could be marginally prolonged safely without causing major neurological complications.

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“…3 The advantages of RCP and RIVP have led clinicians to consider applying total body retrograde perfusion (TBRP) during hypothermic circulatory arrest. 4 Here we provide a cautionary report of two cases of hemiarch replacement at our institution in which TBRP had to be terminated early. Our cases suggest that TBRP may be dangerous for patients.…”

Section: Introductionmentioning

confidence: 93%

Total body retrograde perfusion during hypothermic circulatory arrest is unsafe

et al. 2020

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Retrograde cerebral perfusion and retrograde inferior vena cava perfusion at a pressure of 25 mmHg can protect brain and visceral organs during hypothermic circulatory arrest. Total body retrograde perfusion has been proposed as an alternative during aortic arch surgery. We describe two patients who received total body retrograde perfusion during hemi-arch replacement. The procedure had to be terminated at 8 and 15 minutes due to severe fluid retention and decline in cerebral oxygen saturation. Delirium occurred in one patient after surgery. We concluded that total body retrograde perfusion may be associated with high risk of hypoperfusion and should not be recommended.

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Clinical application of total body retrograde perfusion to operation for aortic dissection

Cited by 40 publications

References 5 publications

Hypothermic Circulatory Arrest and Other Methods of Cerebral Protection During Operations on the Thoracic Aorta

Hypothermic Circulatory Arrest and Other Methods of Cerebral Protection During Operations on the Thoracic Aorta

Postoperative brain complications following retrograde cerebral perfusion

Total body retrograde perfusion during hypothermic circulatory arrest is unsafe

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