Original ArticlesComparative study of retrograde and selective cerebral perfusion with transcranial Doppler
Section snippets
Material and methods
From April 1993 to January 1997, 32 consecutive patients electively underwent resection and graft replacement of ascending aortic, transverse aortic arch, or descending thoracic aortic aneurysms at Kyushu University Hospital. Retrograde cerebral perfusion was used in 15 patients (RCP group) and SCP, in 17 patients (SCP group) for cerebral protection during the reconstruction of the aortic arch. This was a randomized, prospective study, and informed consent was obtained from all patients.
Results
The two groups were similar with respect to operation time (RCP group, 636 ± 183 minutes; SCP group, 656 ± 254 minutes), CPB time (RCP group, 281 ± 87 minutes; SCP group, 271 ± 93 minutes), aortic cross-clamp time (RCP group, 64.4 ± 44.9 minutes; SCP group, 78.4 ± 32.4 minutes), and circulatory arrest time of the lower body (RCP group, 33.4 ± 20.7 minutes; SCP group, 33.8 ± 17.5 minutes). Data on cerebral perfusion are shown in Table 2. The duration of RCP was significantly shorter than that of
Comment
Strategies for protecting the brain during operations for aortic aneurysms involving the aortic arch have evolved into three major categories: HCA, SCP, and RCP. Hypothermic circulatory arrest is the simplest and provides a good operative field but has the disadvantage of a time limit in terms of safety [12]. Selective cerebral perfusion is a useful adjunct when reconstruction of the aortic arch and arch vessels is likely to take a long time. However, SCP requires complicated techniques for
Acknowledgements
This study was supported in part by the Research Grant of Cardiovascular Disease (6C-3) from the Ministry of Health and Welfare, Japan.
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