Total body retrograde perfusion during hypothermic circulatory arrest is unsafe

Retrograde cerebral perfusion and retrograde inferior vena cava perfusion at a pressure of 25 mmHg can protect brain and visceral organs during hypothermic circulatory arrest. Total body retrograde perfusion has been proposed as an alternative during aortic arch surgery. We describe two patients who received total body retrograde perfusion during hemi-arch replacement. The procedure had to be terminated at 8 and 15 minutes due to severe fluid retention and decline in cerebral oxygen saturation. Delirium occurred in one patient after surgery. We concluded that total body retrograde perfusion may be associated with high risk of hypoperfusion and should not be recommended.

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Unclamping the inferior vena cava during retrograde cerebral perfusion increases the safe range of retrograde perfusion pressures and improves brain perfusion

Interactive Cardiovascular and Thoracic Surgery ◽

10.1016/j.icvts.2003.12.001 ◽

2004 ◽

Vol 3 (2) ◽

pp. 265-269 ◽

Cited By ~ 4

Author(s):

Z Li

Keyword(s):

Inferior Vena Cava ◽

Cerebral Perfusion ◽

Inferior Vena ◽

Vena Cava ◽

Brain Perfusion ◽

Retrograde Cerebral Perfusion ◽

Retrograde Perfusion

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Continuous retrograde cerebral perfusion supplies substrates for brain metabolism during hypothermic circulatory arrest

Perfusion ◽

10.1177/026765919501000406 ◽

1995 ◽

Vol 10 (4) ◽

pp. 237-244 ◽

Cited By ~ 6

Author(s):

Suat Buket ◽

Alp Alayunt ◽

Berent Discigil ◽

Anil Apaydin ◽

Munevver Yuksel ◽

...

Keyword(s):

Glucose Level ◽

Superior Vena Cava ◽

Cerebral Perfusion ◽

Carotid Arteries ◽

Circulatory Arrest ◽

Superior Vena ◽

Vena Cava ◽

Hypothermic Circulatory Arrest ◽

Brain Protection ◽

Retrograde Cerebral Perfusion

Ten patients underwent replacement of ascending aorta and/or aortic arch with aneurysm or dissection, using hypothermic circulatory arrest (HCA) with retrograde cerebral perfusion (RCP). RCP was administered through the superior vena cava cannula continuously during HCA (15°C to 20°C). Mean HCA time was 32 minutes (range, 18-45 minutes). To assess the metabolic changes during RCP, blood samples were taken from carotid arteries and the superior vena cava cannula simultaneously, five minutes after the onset and five minutes prior to termination of continuous retrograde cerebral perfusion (CRCP) for analysis of blood gas and glucose level. One patient died intraoperatively due to left ventricular failure. Nine patients survived their operations and all except one with stroke due to partial intimal flap obstruction of innominate artery awoke neurologically intact within four to six hours. One patient died on the postoperative fifth day due to septic shock following resection of ischaemic bowel due to dissection involving the mesenteric artery. Oxygen saturation, pH and glucose level were all found to be lower in blood back-bleeding from the carotid arteries than in blood perfused through the superior vena cava cannula at all sampling times during HCA and CRCP (p < 0.05). Although oxygen and glucose extraction is not only from brain tissue, these data demonstrate the efficacy of CRCP in supplying substrates for brain protection. CRCP is a reliable method as an adjunct to HCA for brain protection.

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