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J Thorac Cardiovasc Surg 2001;121:425-427
© 2001 The American Association for Thoracic Surgery
Editorials |
From the Department of Cardiothoracic Surgery, Mount Sinai School of Medicine, New York, NY.
Received for publication Dec 8, 2000. Accepted for publication Dec 12, 2000. Address for reprints: Randall B. Griepp, MD, Department of Cardiothoracic Surgery, The Mount Sinai Medical Center, One Gustave L. Levy Place, Box 1028, New York, NY 10029.
For related article, see p. 491.
In this issue of the Journal, Kazui and associates
1 report an outstanding series of patients with aortic arch operations, with an exceptionally low mortality and incidence of neurologic complications. This is the latest in a series of reports by Kazui, who has been a pioneer championing the use of antegrade cerebral perfusion during these operations. He is to be congratulated for his independence, ingenuity, and skill, documenting ever-improving results of aneurysm operations in this elderly, high-risk population and providing exemplary leadership in devising improved techniques for cerebral protection during aortic surgery.
In the hands of most aortic surgeons, results of aortic arch surgery have been improving gradually, although few can claim results quite so good as Kazui's. Neurologic damage is a frequent cause of death and complications after these operations, as a result either of focal thromboembolic episodes or of global ischemia during arrest of antegrade cerebral circulation. Various approaches are currently being used throughout the world to try to reduce the incidence of both kinds of neurologic complications. In addition to clinical studies, such as that of Kazui, laboratory investigations have also contributed to an understanding of how best to protect the brain during surgery that requires interruption of normal cerebral perfusion. What follows is a discussion of the benefits and possible drawbacks of each of the techniques for cerebral protection currently used clinically. Some specific precautions to avoid embolization during these procedures are also suggested.
Hypothermic circulatory arrest
Hypothermic circulatory arrest (HCA) was the first technique to gain wide acceptance for use in surgery of the aortic arch. 2 It has the virtue of simplicity, permitting a field essentially free of blood and cannulas, allowing thorough inspection of the aneurysm and a careful open distal anastomosis. However, awareness of a relatively high incidence of neurologic complications
Related Article
J. Thorac. Cardiovasc. Surg. 2001 121: 491-499.
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