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Ann Thorac Surg 1996;61:1354
© 1996 The Society of Thoracic Surgeons

Invited Commentary

Invited Commentary

Julie A. Swain, MD

Bakey Heart Institute, Kenosha Hospital and Medical Center, 6308 Eighth Ave, Kenosha, WI 53143

See also page 1348.

This article represents an important contribution to the literature on brain protection from a leading research group. For the first time, brain function (as measured by evoked potentials) is correlated with biochemical and metabolic measurements. Sakurada and associates conclude that antegrade cerebral perfusion is the ``safest method'' of brain protection in aortic arch reconstruction and that retrograde cerebral perfusion is minimally effective. However, their data are subject to alternative interpretation. The recent recognition of the contribution of extensive venous collaterals through the inferior vena cava and the azygous systems to retrograde cerebral perfusion are negated by the experimental model used in this study. The use of a normal (ie, nonatherosclerotic) animal model ignores the importance of atheromatous and air emboli to postoperative neurologic damage, a major concern with selective cerebral perfusion.

Despite the limitations of the experimental model, authors have collected important data demonstrating the cerebroprotective effects of retrograde perfusion in minimizing aerobic metabolism and have shown a possible deleterious increase in tissue water requiring further study. Careful studies of postoperative neurologic and psychological function are urgently needed in this field. A very important contribution of this study should be to temper the enthusiasm of those who have espoused retrograde cerebral perfusion as the final answer to the quest for cerebral protection. A technically correct, expeditious operation still provides the patient with the best chance of recovery.


Related Article

Comparative Experimental Study of Cerebral Protection During Aortic Arch Reconstruction
Taku Sakurada, Teruhisa Kazui, Hisashi Tanaka, and Sakuzo Komatsu
Ann. Thorac. Surg. 1996 61: 1348-1354. [Abstract] [Full Text]




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