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Randall B. Griepp
Robert Bonser
Axel Haverich
Teruhisa Kazui
Nicholas T. Kouchoukos
Hazim J. Safi
David Spielvogel
Shinichi Takamoto
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Ann Thorac Surg 2007;83:S824-S831
© 2007 The Society of Thoracic Surgeons

Supplement

Panel Discussion: Session II—Aortic Arch

Randall B. Griepp, MD, Moderator, Robert Bonser, FRCS, FRCP, Panelist, Axel Haverich, MD, PhD, Panelist, Teruhisa Kazui, MD, Panelist, Nicholas T. Kouchoukos, MD, Panelist, Hazim J. Safi, MD, Panelist, Hiroaki Sasaki, MD, Panelist, David Spielvogel, MD, Panelist, Shinichi Takamoto, MD, Panelist

Presented at Aortic Surgery Symposium X, New York, NY, April 27–28, 2006.

The first 300 words of the full text of this article appear below.

DR RANDALL B. GRIEPP (New York, NY): As the essayists are assembling, let me just ask a few questions, for my own information, of the audience with regard to arch surgery. Could I just have a show of hands of those of you who do a reasonable number of arch replacements or feel comfortable doing arch surgery? It looks like perhaps half. Let me ask then, of those of you who responded, how many of you rely just on hypothermic circulatory arrest and do not use any other type of cerebral protection: HCA only? A pretty small number, maybe 5%. How many of you use retrograde cerebral perfusion at least in some of your patients or at some point in the operative procedure? It looks like 15% or 20%. How about antegrade cerebral perfusion? That looks like probably the other 80%.

Let me just ask one multipart question of the panelists, if I could, just as sort of a poll of our experts. Would any of you use any form of cerebral protection other than HCA if you were confident that your period of cerebral ischemia is going to be limited to less than 30 minutes? That is the first part. Secondly, those of you who use selective cerebral perfusion, what do you use as the parameters for the perfusion: how do decide on flow, pressure, temperature, etc? What are the parameters that you use? And finally, do you use any form of monitoring to assure the adequacy of the perfusion that you are providing? This is with selective cerebral perfusion.

DR NICHOLAS T. KOUCHOUKOS (St. Louis, MO): As far as less than 30 minutes for hemiarch and procedures that do not require an extensive replacement of the entire arch, we are comfortable with hypothermic circulatory arrest and use retrograde . . . [Full Text of this Article]




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