Abstract
Introduction
Retrograde cerebral perfusion (RCP) is a safe and effective technique to augment cerebral
protection during lower body circulatory arrest in patients undergoing elective hemiarch
replacement. However, recommendations guiding optimal temperature, flow rate, and
perfusion pressure are outdated and potentially overly limiting. We report our experience
using RCP for elective hemiarch replacement with parameters that challenge the currently
accepted paradigm.
Methods
This was a single-center, retrospective analysis of 319 adult patients who underwent
elective hemiarch replacement between February 2010 and 2021 using hypothermic lower
body circulatory arrest with RCP alone, RCP followed by antegrade cerebral perfusion
(ACP), or ACP alone. Flow rates were adjusted to maintain cerebral perfusion pressure
between 30 and 50 mm Hg for RCP and between 40 and 60 mm Hg for ACP.
Results
RCP was used in 22.6% (n = 72) of cases, whereas ACP alone was performed in 77.4% (n = 247) of cases. Baseline patient characteristics were similar between groups. Patients
undergoing RCP demonstrated shorter cross-clamp time (97.0 min versus 100.0 min, P = 0.034) and shorter lower body circulatory arrest time (7.0 min versus 10.0 min, P < 0.0001) compared with ACP alone. Nadir bladder temperature was equivalent between
groups (27.3°C versus 27.5°C, P = 0.752). There were no significant differences in postoperative complications, neurologic
outcomes, or mortality.
Conclusions
Moderate hypothermic lower body circulatory arrest combined with RCP at target perfusion
pressures of 30-50 mm Hg in patients undergoing elective hemiarch replacement results
in equivalent neurologic outcomes and overall morbidity to cases using ACP alone.
These results challenge the currently accepted paradigm for RCP, which typically uses
deep hypothermia while keeping perfusion pressures below 25 mm Hg.
Keywords
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Article info
Publication history
Published online: November 30, 2022
Accepted:
October 24,
2022
Received in revised form:
October 19,
2022
Received:
April 29,
2022
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
