1. Combining Cerebral Perfusion With Retrograde Inferior Vena Caval Perfusion for Aortic Arch Surgery 
Jing Lin, MD, Jiyue Xiong, MS, Ming Luo, MS, Zhaoxia Tan, MS, Zhong Wu, MD, Yingqiang Guo, MD, Lei Du, MD, PhD 
The Annals of Thoracic Surgery 
Volume 107, Issue 1, Pages e67-e69 (January 2019)
DOI: /j.athoracsur
Copyright © 2019 The Society of Thoracic Surgeons Terms and Conditions

2. Fig 1
Schematic of the bypass circuit and its connection with the body. (A) Before and after retrograde inferior vena caval perfusion, venous blood from the (1) superior vena cava and (2) inferior vena cava is returned to the reservoir and driven by pump 1 to the oxygenator and then back to the artery (3) via a filter, where pressure is monitored (5). (B) During retrograde inferior vena caval perfusion, venous blood from the (1) superior vena cava is returned to the reservoir and driven by pump 1 to the oxygenator. Part of the oxygenated blood is routed for antegrade cerebral perfusion (4), while the other part is driven by pump 2 back to the lower body via the (2) inferior vena cava. Circulatory pressure is monitored (6).
The Annals of Thoracic Surgery  , e67-e69DOI: ( /j.athoracsur )
Copyright © 2019 The Society of Thoracic Surgeons Terms and Conditions

3. Fig 2
During retrograde inferior vena caval perfusion, blood flow was observed in liver (A, white arrow) and kidney (B, yellow arrow) using transesophageal echocardiography.
The Annals of Thoracic Surgery  , e67-e69DOI: ( /j.athoracsur )
Copyright © 2019 The Society of Thoracic Surgeons Terms and Conditions

4. Fig 3
Clear surgical field acquired using a suction tube (yellow arrow) inserted directly into the elephant trunk implant (A) or into the graft (B).
The Annals of Thoracic Surgery  , e67-e69DOI: ( /j.athoracsur )
Copyright © 2019 The Society of Thoracic Surgeons Terms and Conditions