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Ann Thorac Surg 2000;69:319
© 2000 The Society of Thoracic Surgeons

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Correspondence

Cerebral perfusion and transcranial Doppler

^a Cardiac Surgery Unit, Basurto Hospital, Bilbao 48013, Spain

e-mail: aortiz{at}hbas.osakidetza.net

To the Editor

We congratulate Tanoue and colleagues on their brilliant study about cerebral perfusion during circulatory arrest [1]. We have a few questions. First, when they present the study as randomized, one variable in the surgical technique is not taken into account, namely, the arterial perfusion that is undertaken "to the ascending aorta or the left femoral artery." Several groups [2, 3] have identified perfusion through the femoral artery as a possible cause of stroke. We think the authors should specify how many patients received each technique.

Second, in this study, retrograde cerebral perfusion was undertaken "through the superior vena cava to the internal jugular vein." Deeb and coworkers [4] recommended that perfusion be selective through the jugular vein, apart from the innominate vein, to prevent shunting of blood to the inferior half of the body through the azygos and hemiazygos circuit and, besides not completely exsanguinating the patient, to maintain venous pressure in the inferior part of the body and thus decrease the proportion of venous shunting. It is possible that these measures could influence the detection or lack thereof of the Doppler flow signal in the middle cerebral artery. We believe that it is not the objective of retrograde cerebral perfusion, but rather it is to maintain cerebral hypothermia, flush microemboli, and reduce the potential for air embolism. The fact that 3 patients in their selective cerebral perfusion group had a stroke, most probably caused by emboli, confirms our impressions.

We think the report by Tanoue and associates [1] is interesting and contributes to the surgical management of cerebral protection.

References

1. Tanoue Y., Tominaga R., Ochiai Y., et al. Comparative study of retrograde and selective cerebral perfusion with transcranial Doppler. Ann Thorac Surg 1999;67:672-675.[Abstract/Free Full Text]
2. Von Segesser L.K., Killer I., Ziswiler M., et al. Dissection of the descending aorta extending into the ascending aorta. J Thorac Cardiovasc Surg 1994;108:755-761.[Abstract/Free Full Text]
3. Kouchoukos N.T. Adjuncts to reduce the incidence of embolic brain injury during operations on the aortic arch. Ann Thorac Surg 1994;57:243-245.[Abstract]
4. Deeb G.M., Jenkins E., Bolling S.F., et al. Retrograde cerebral perfusion during hypothermic circulatory arrest reduces neurologic morbidity. J Thorac Cardiovasc Surg 1995;109:259-268.[Abstract/Free Full Text]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by de Salazar, A. O. Articles by Izaguirre, J. L. Search for Related Content PubMed Articles by de Salazar, A. O. Articles by Izaguirre, J. L.