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Retrograde Cerebral Perfusion as an Adjunct to Prolonged Hypothermic Circulatory Arrest^*

^* From the Department of Surgery, University of California at Los Angeles Medical Center, Los Angeles, CA.

Correspondence to: Fardad Esmailian, MD, FCCP, UCLA School of Medicine, Division of Cardiothoracic Surgery, 10833 LeConte Ave, 62–266 CHS, Los Angeles, CA 90095-1741; e-mail: fesmaili{at}surgery.medsch.ucla.edu

Study objective: This study was designed to evaluate the use of retrograde cerebral perfusion (RCP) combined with deep hypothermic circulatory arrest (DHCA) in the treatment of complex congenital and adult cardiac disease.

Design: Retrospective chart review of 52 cardiac surgery patients (34 male and 18 female; age range, 3 weeks to 89 years old; mean age, 60 years old) who received RCP in conjunction with DHCA from July 1991 through August 1998.

Results: Surgical procedures consisted of the following: (1) repair of ascending aortic aneurysms (n = 16); (2) repair of type A aortic dissection (n = 16); (3) repair of arch aneurysms (n = 10); (4) renal cell carcinoma with tumor extension to the inferior vena cava (IVC) and right atrium (n = 5); (6) coronary artery bypass grafting and concomitant aortic valve replacement with calcified aorta (n = 2); (7) Norwood procedure and take down of a Pott's shunt (n = 2); and (8) massive air embolism treatment (n = 1). Mean RCP time was 39 min (range, 3 to 88 min). Thirteen patients had RCP times > 60 min. Mean core temperature (rectal or bladder) was 19°C (range, 15° to 28°C). There were six early deaths, four of which were related to persistent low-output cardiac failure, and two resulted from perioperative stroke. All remaining patients recovered fully without neurologic deficits.

Conclusion: RCP is a reliable and technically appealing tool that does the following: (1) it improves DHCA safety and is applicable in a variety of clinical settings with relative ease; (2) it potentially provides oxygen and nutritional support to the brain during DHCA; (3) it helps remove air and other debris from the cerebral vessels; and (4) it is useful in dealing with congenital heart disease and tumor extension into the IVC.

Key Words: aortic dissection • circulatory arrest • retrograde cerebral perfusion

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