A study of brain protection during total arch replacement comparing antegrade cerebral perfusion versus hypothermic circulatory arrest, with or without.

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A study of brain protection during total arch replacement comparing antegrade cerebral perfusion versus hypothermic circulatory arrest, with or without retrograde cerebral perfusion: Analysis based on the Japan Adult Cardiovascular Surgery Database Yutaka Okita, MD, Hiroaki Miyata, PhD, Noboru Motomura, MD, Shinichi Takamoto, MD The Journal of Thoracic and Cardiovascular Surgery Volume 149, Issue 2, Pages S65-S73 (February 2015) DOI: 10.1016/j.jtcvs.2014.08.070 Copyright © 2015 The American Association for Thoracic Surgery Terms and Conditions

Figure 1 Patient selection. ACP, Antegrade cerebral perfusion; HCA, hypothermic circulatory arrest; RCP, retrograde cerebral perfusion; DHCA, deep hypothermic circulatory arrest. The Journal of Thoracic and Cardiovascular Surgery 2015 149, S65-S73DOI: (10.1016/j.jtcvs.2014.08.070) Copyright © 2015 The American Association for Thoracic Surgery Terms and Conditions

Figure 2 ACP. A, Direct cannulation of the neck vessels, without tourniquet, using serrated balloon tipped cannulae. To prevent left recurrent nerve injury, direct enucleation of the proximal end of the descending aorta was performed and dissection of the descending aorta with dividing of the upper intercostal arteries was performed. B, Distal anastomosis using a 4-0 monofilament SH-1 needle with felt strip reinforcement, starting at 9 o'clock and proceeding counterclockwise. A flexible sucker was positioned inside the graft. C, Initiating antegrade lower body perfusion and rewarming. The proximal anastomosis is constructed with a 4-0 monofilament RB-1 needle and felt strip, and the neck vessel anastomoses are performed using 5-0 monofilament sutures. The Journal of Thoracic and Cardiovascular Surgery 2015 149, S65-S73DOI: (10.1016/j.jtcvs.2014.08.070) Copyright © 2015 The American Association for Thoracic Surgery Terms and Conditions

Figure 3 A-C, HCA with RCP (old technique). A, Distal anastomosis first. B, Anastomosis to the left common carotid artery. C, Start to reperfuse the brain and lower body. D-F, HCA with RCP (4-branch graft, arch first technique). D, If possible, balloon occlusion of the descending aorta and perfusion from the femoral artery were performed. First, anastomosis to the brachiocephalic artery was performed. E, ACP was initiated from the side branch of the graft. F, Then distal aortic anastomosis, left carotid artery, left subclavian artery, and proximal anastomosis were performed. The Journal of Thoracic and Cardiovascular Surgery 2015 149, S65-S73DOI: (10.1016/j.jtcvs.2014.08.070) Copyright © 2015 The American Association for Thoracic Surgery Terms and Conditions