SURGICAL-TREATMENT OF ANEURYSMS OF THE AORTIC-ARCH USING A SIMPLIFIED SELECTIVE CEREBRAL PERFUSION TECHNIQUE

Between April 1989 and October 1993, 35 patients underwent aortic arch reconstruction for aneurysms using cardiopulmonary bypass (CPB) with selective cerebral perfusion (SCP). Of the 35 patients, the initial 19 (Group P) consecutively received simplified SCP (partial brachiocephalic perfusion; PBP), and the next 16 (Group S) were consecutively treated with standard SCP. For cerebral protection, blood was supplied to the right axillary artery in Group P, and to the right axillary and the left common carotid arteries in Group S. The aneurysm was aortic dissection in 24 patients, and was secondary to arteriosclerosis in the remaining 11. Partial replacement of the aortic arch together with the ascending aorta was the most commonly performed procedure in both groups. The cardiopulmonary bypass time and the cardiac arrest time were not significantly different between the two groups. The overall cerebral perfusion time was significantly longer in Group S (100 min) than in Group P (65 min); however, when 2 patients with an accidental prolongation of the cerebral perfusion time in Group S were excluded, there was no significant difference in the cerebral perfusion time between the two groups. Early death occurred in 3 patients (15.8%) in Group P, and 2 patients (12.5%) in Group S, however, there were no deaths related to the selective cerebral perfusion technique, and there were no late deaths in either group. Cerebral complications were seen in 1 patient in each group (6.3% vs. 6.7%, not significant). These results suggest that the simplified SCP (PBP) under hypothermic CPB provides as satisfactory cerebral protection as standard SCP, so long as the patency of the circle of Willis is confirmed. The potential advantages of this technique, in addition to satisfactory cerebral protection, are technical simplicity and excellent exposure of the operative field.