Simple hypothermic retrograde cerebral perfusion during aortic arch replacement. A preliminary report on two successful cases.

We recently found that hypothermic retrograde cerebral perfusion can be performed by simply elevating the central venous pressure in Trendelenburg's position while the aortic arch is open. In this technique, with an occlusion balloon in the descending aorta, deep hypothermic perfusion of the lower half of the body is performed as oxygen-rich venous blood supplies the brain. Two successful cases are reported: one of dissecting aortic aneurysm, DeBakey type II, with a true aortic arch aneurysm, in a 53-year-old woman, and one of acute aortic dissection, DeBakey type I, in a 53-year-old man. With the brain under retrograde perfusion at a rectal temperature of 15 degrees C and a central venous pressure of 15 mm Hg, replacement of the ascending to the descending aorta in the former case and to the proximal aortic arch in the latter case was successful. Cerebral circulatory arrest times were 81 and 65 minutes, respectively. No neurologic deficit was found postoperatively. It is suggested that this simple technique protected the brain for a long period of cerebral circulatory arrest during the aortic arch operation by supplying it with oxygen and simplifying the operative procedure.