Open aortic arch surgery: how to reduce air embolism risk during antegrade cerebral perfusion

Abstract

Antegrade cerebral perfusion (ACP) is used widely, with the aim of obtaining cerebral protection during open aortic arch surgery. ACP is considered by many to be the reason for improvements in the clinical outcome of this type of surgery. However, perioperative cerebral complications may still occur. Cerebral complications during ACP are considered to be due mainly to embolic events rather than hypoperfusion. We believe that many of the embolic events during ACP may be due to air embolism rather than to vessel manipulation only. To reduce the risk of air embolism during ACP, we propose an easy technique, with the suggested steps to be followed in an exact sequence.

Keywords

aorta/aortic aortic arch aortic operation aortic dissection cerebral protection perfusion

References

Apostolakis E. , Akinosoglou K. The methodologies of hypothermic circulatory arrest and of antegrade and retrograde cerebral perfusion for aortic arch surgery. Ann Thorac Cardiovasc Surg 2008; 14(3): 138-148.

Mishra PK , Bhan A. , Sharma R. , Kiran U. , Gupta RK , Venugopal P. Retrograde cerebral perfusion for brain protection in aortic aneurysm surgery . J Cardiovasc Med 2009; 10: 34-38.

Lentini S. Cerebral perfusion strategies during aortic surgery. J Cardiovasc Med (Hagerstown). 2009; 10(10): 818-819.

Munakata H. , Okada K. , Hasegawa T. , et al. Controlled low-flow reperfusion after warm brain ischemia reduces reperfusion injury in canine model. Perfusion 2010 May; 25(3): 159-168.

Zhang H. , Cheng P. , Hou J. , et al. Regional cerebral perfusion for surgical correction of neonatal aortic arch obstruction. Perfusion 2009 May; 24(3): 185-189

Kaul P. , Javangula K. , Ganti S. , et al. Continuous selective bilateral antegrade cerebral perfusion through anomalous innominate artery for repair of root, ascending aortic and arch aneurysm - challenges, vagaries and opportunities of bovine arch variant anatomy and review of literature. Perfusion 2009 Mar; 24(2): 121-133

Macrina F. , Capelli A. , Trigilia F. , et al. A simple circuit for cerebral perfusion during cardiopulmonary bypass surgery of the ascending aorta and the aortic arch. Perfusion 2010 Mar; 25(2): 83-86.