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Simultaneous Selective Cerebral Perfusion and Systemic Circulatory Arrest Through the Right Axillary Artery for Aortic Surgery
Author(s) -
Byrne John G.,
Fitzgerald Daniel J.,
Aranki Sary F.
Publication year - 1998
Publication title -
journal of cardiac surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.428
H-Index - 58
eISSN - 1540-8191
pISSN - 0886-0440
DOI - 10.1111/j.1540-8191.1998.tb01061.x
Subject(s) - medicine , cerebral perfusion pressure , axillary artery , circulatory system , cardiopulmonary bypass , ascending aorta , perfusion , aortic arch , anastomosis , retrograde perfusion , aorta , cardiology , aortic dissection , anesthesia , surgery
The duration of safe circulatory arrest for replacement of the ascending aorta for a type A dissection, without additional cerebral perfusion measures, is not clearly defined. If prolonged periods (> 60 minutes) are anticipated, retrograde cerebral perfusion or selective ante‐grade carotid perfusion may be required. The latter requires separate cannulas with subsequent snaring of the cerebral vessels, which may be time consuming and cumbersome. We propose an alternative method whereby the right axillary artery is cannulated for cardiopulmonary bypass and, when the desired hypothermic temperature is achieved, the flows are turned down to 500 mL/min. The origin of the innominate artery is then occluded establishing selective antegrade right carotid artery perfusion. The distal ascending or aortic arch anastomosis is then performed while the remainder of the body is under selective systemic circulatory arrest. The proximal aortic anastomosis is performed after the graft is clamped proximally and flows return to appropriate perfusion levels. (J Card Surg 7 998;4:236–238)