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Ann Thorac Surg 1999;67:1874-1878
© 1999 The Society of Thoracic Surgeons

Antegrade cerebral perfusion with cold blood: a 13-year experience

Jean Bachet, MDa, David Guilmet, MDa, Bertrand Goudot, MDa, Gilles D. Dreyfus, MDa, Philippe Delentdecker, MDa, Denis Brodaty, MDa, Claude Dubois, MDa

a Service de Chirurgie Cardio-vasculaire, Hopital Foch - Universite Rene Descartes, Suresnes, France

Address reprint requests to Dr Bachet, Hopital Foch, 40 rue Worth, 92150 Suresnes, France

Presented at the Aortic Surgery Symposium VI, April 30–May 1, 1998, New York, NY.

Background. In 1986 we introduced the technique of antegrade selective perfusion of the brain with cold blood during surgery of the aortic arch.

Methods. Between January 1984 and March 1998, 171 patients (118 males and 53 females) aged 25 to 83 years (mean 56.5 ± 17), underwent replacement of the transverse aortic arch with the aid of cold blood antegrade selective perfusion. One hundred twenty two patients (71.3%) with chronic lesions were operated on electively; 49 patients (28.6%) were operated on urgently for acute aortic dissection (42 patients) or for a ruptured chronic aneurysm (7 patients). Fifty-one patients (29.8%) had previously undergone a surgical procedure on the thoracic aorta. Mean duration of cardiopulmonary bypass was 121 minutes (range: 65–248); mean duration of cerebral perfusion was 60 minutes (range: 15–90), and mean duration of systemic circulatory arrest circuit was 32 minutes (range: 10–57). The electroencephalogram, routinely recorded, showed disappearance of electrical activity in a mean of 9 minutes (range: 3–16) initial return of electrical activity after a mean of 12 minutes (range: 1–35) and normalization in a mean time of 66 minutes.

Results. All patients but 7 (4%) showed signs of normal awakening within 8 hours postoperatively. Six patients (3.5%) had fatal neurologic complications, and 16 patients (9.3%) had a non-fatal neurologic complications. Twenty-nine patients (16.9%) died during the post-operative hospital course. There was a significant difference between patients aged less than 60 years (9%) and patients older than 60 years (mortality rate 26.4%, p < 0.02). There was also a significant difference between patients undergoing an isolated replacement of the arch, and those in whom the replacement was extended to the descending aorta in whom mortality was 36.4% ({chi}2, p < 0.02). Lesion and gender had no significant influence on the outcome of the patients, nor had the duration of cardiopulmonary bypass, circulatory arrest, and cerebral perfusion. In particular, no correlation could be established between the duration of cerebral perfusion and the occurrence of neurologic complications.

Conclusion. The clinical results obtained throughout this experience have demonstrated that selective antegrade cerebral perfusion with cold blood provides excellent protection during surgery of the transverse aortic arch. In addition, it avoids the use of deep hypothermia and prolonged cardiopulmonary bypass and does not limit the time allowed to perform the aortic repair. In our opinion it is the technique of choice, especially in frail patients or those requiring a long and difficult procedure.




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 Eur J Cardiothorac SurgHome page
C. Hagl, N. Khaladj, M. Karck, K. Kallenbach, R. Leyh, M. Winterhalter, and A. Haverich
Hypothermic circulatory arrest during ascending and aortic arch surgery: the theoretical impact of different cerebral perfusion techniques and other methods of cerebral protection
Eur J Cardiothorac Surg, September 1, 2003; 24(3): 371 - 378.
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 J. Thorac. Cardiovasc. Surg.Home page
M. Karck, A. Chavan, C. Hagl, H. Friedrich, M. Galanski, and A. Haverich
The frozen elephant trunk technique: A new treatment for thoracic aortic aneurysms
J. Thorac. Cardiovasc. Surg., June 1, 2003; 125(6): 1550 - 1553.
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 Eur J Cardiothorac SurgHome page
S. Numata, H. Ogino, H. Sasaki, Y. Hanafusa, M. Hirata, M. Ando, and S. Kitamura
Total arch replacement using antegrade selective cerebral perfusion with right axillary artery perfusion
Eur J Cardiothorac Surg, May 1, 2003; 23(5): 771 - 775.
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 Eur J Cardiothorac SurgHome page
C. Hagl, N. Khaladj, T. Peters, M. M. Hoeper, F. Logemann, A. Haverich, and P. Macchiarini
Technical advances of pulmonary thromboendarterectomy for chronic thromboembolic pulmonary hypertension
Eur J Cardiothorac Surg, May 1, 2003; 23(5): 776 - 781.
[Abstract] [Full Text] [PDF]

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 J. Thorac. Cardiovasc. Surg.Home page
A. Haverich and C. Hagl
Organ protection during hypothermic circulatory arrest
J. Thorac. Cardiovasc. Surg., March 1, 2003; 125(3): 460 - 462.
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 Card Surg AdultHome page
R. Pretre and M. I. Turina
Deep Hypothermic Circulatory Arrest
Card. Surg. Adult, January 1, 2003; 2(2003): 401 - 412.
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 Ann. Thorac. Surg.Home page
L. G. Svensson, E. M. Nadolny, and W. A. Kimmel
Multimodal protocol influence on stroke and neurocognitive deficit prevention after ascending/arch aortic operations
Ann. Thorac. Surg., December 1, 2002; 74(6): 2040 - 2046.
[Abstract] [Full Text] [PDF]

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 Ann. Thorac. Surg.Home page
L. G. Svensson
Progress in ascending and aortic arch surgery: minimally invasive surgery, blood conservation, and neurological deficit prevention
Ann. Thorac. Surg., November 1, 2002; 74(5): S1786 - S1788.
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 Ann. Thorac. Surg.Home page
T. Kazui, K. Yamashita, N. Washiyama, H. Terada, A. H. M. Bashar, T. Suzuki, and K. Ohkura
Usefulness of antegrade selective cerebral perfusion during aortic arch operations
Ann. Thorac. Surg., November 1, 2002; 74(5): S1806 - S1809.
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 Ann. Thorac. Surg.Home page
D. Spielvogel, J. T. Strauch, O. P. Minanov, S. L. Lansman, and R. B. Griepp
Aortic arch replacement using a trifurcated graft and selective cerebral antegrade perfusion
Ann. Thorac. Surg., November 1, 2002; 74(5): S1810 - S1814.
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 Ann. Thorac. Surg.Home page
M. R. Moon and T. M. Sundt III
Influence of retrograde cerebral perfusion during aortic arch procedures
Ann. Thorac. Surg., August 1, 2002; 74(2): 426 - 431.
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 Ann. Thorac. Surg.Home page
O. Tasdemir, A. Saritas, S. Kucuker, M. A. Ozatik, and E. Sener
Aortic arch repair with right brachial artery perfusion
Ann. Thorac. Surg., June 1, 2002; 73(6): 1837 - 1842.
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 Ann. Thorac. Surg.Home page
J. M. Pearl, D. P. Nelson, S. M. Schwartz, and P. B. Manning
First-stage palliation for hypoplastic left heart syndrome in the twenty-first century
Ann. Thorac. Surg., January 1, 2002; 73(1): 331 - 339.
[Abstract] [Full Text] [PDF]

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 J. Thorac. Cardiovasc. Surg.Home page
L. J. Goldstein, R. R. Davies, J. A. Rizzo, J. J. Davila, M. R. Cooperberg, R. K. Shaw, G. S. Kopf, and J. A. Elefteriades
Stroke in surgery of the thoracic aorta: Incidence, impact, etiology, and prevention
J. Thorac. Cardiovasc. Surg., November 1, 2001; 122(5): 935 - 945.
[Abstract] [Full Text] [PDF]

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 Ann. Thorac. Surg.Home page
L. G. Svensson, E. M. Nadolny, D. L. Penney, J. Jacobson, W. A. Kimmel, M. H. Entrup, and R. S. D'Agostino
Prospective randomized neurocognitive and S-100 study of hypothermic circulatory arrest, retrograde brain perfusion, and antegrade brain perfusion for aortic arch operations
Ann. Thorac. Surg., June 1, 2001; 71(6): 1905 - 1912.
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 Eur J Cardiothorac SurgHome page
R. Di Bartolomeo, M. Di Eusanio, D. Pacini, M. Pagliaro, C. Savini, A. Nocchi, and A. Pierangeli
Antegrade selective cerebral perfusion during surgery of the thoracic aorta: risk analysis
Eur J Cardiothorac Surg, June 1, 2001; 19(6): 765 - 770.
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 Eur J Cardiothorac SurgHome page
C. Hagl, J. D. Galla, D. Spielvogel, S. L. Lansman, R. Squitieri, C. A. Bodian, M. A. Ergin, and R. B. Griepp
Is aortic surgery using hypothermic circulatory arrest in octogenarians justifiable?
Eur J Cardiothorac Surg, April 1, 2001; 19(4): 417 - 423.
[Abstract] [Full Text] [PDF]

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 J. Thorac. Cardiovasc. Surg.Home page
T. Kazui, N. Washiyama, B. A. H. Muhammad, H. Terada, K. Yamashita, and M. Takinami
Improved results of atherosclerotic arch aneurysm operations with a refined technique
J. Thorac. Cardiovasc. Surg., March 1, 2001; 121(3): 491 - 499.
[Abstract] [Full Text] [PDF]

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 Ann. Thorac. Surg.Home page
K. Kawahito, H. Adachi, A. Yamaguchi, and T. Ino
Early and late surgical outcomes of acute type a aortic dissection in patients aged 75 years and older
Ann. Thorac. Surg., November 1, 2000; 70(5): 1455 - 1459.
[Abstract] [Full Text] [PDF]

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 Eur J Cardiothorac SurgHome page
H. Takano, T. Sakakibara, R. Matsuwaka, T. Hori, N. Sakagoshi, and N. Shinohara
The safety and usefulness of cool head-warm body perfusion in aortic surgery
Eur J Cardiothorac Surg, September 1, 2000; 18(3): 262 - 269.
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 Eur J Cardiothorac SurgHome page
N. Shiiya, T. Kunihara, M. Imamura, T. Murashita, Y. Matsui, and K. Yasuda
Surgical management of atherosclerotic aortic arch aneurysms using selective cerebral perfusion: 7-year experience in 52 patients
Eur J Cardiothorac Surg, March 1, 2000; 17(3): 266 - 271.
[Abstract] [Full Text] [PDF]


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