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J Thorac Cardiovasc Surg 2002;124:1068-1070
© 2002 The American Association for Thoracic Surgery

Editorials

Antegrade perfusion during suspended animation?

From the Center for Aortic Surgery and Marfan Syndrome Clinic, Department of Thoracic and Cardiovascular Surgery/F25, Cleveland Clinic Foundation, Cleveland, Ohio.

Received for publication April 26, 2002. Accepted for publication May 21, 2002. Address for reprints: Lars G. Svensson, MD, PhD, Director, Center for Aortic Surgery, Marfan Syndrome and Connective Tissue Disorder Clinic, Department of Thoracic and Cardiovascular Surgery/F25, Cleveland Clinic Foundation, Cleveland, OH 44195 (E-mail: svenssl@ccf.org).

The first 20% of the full text of this article appears below.

See related article on page 1080.

For the life of all flesh is the blood thereof.

        —Leviticus 17:14

There are three important considerations when deciding whether to use antegrade brain perfusion during aortic surgery in the continuing quest to prevent, or at least significantly reduce, neurologic deficits. First, primum non nocere, do no harm. Second, how is the risk of embolism-related stroke affected? Third, what are the neurocognitive consequences?

In the early history of aortic surgery when the principle of "do no harm" was the foremost issue, the literature was replete with the high risks of strokes associated with antegrade brain perfusion. Indeed, Crawford and Saleh ¹ reported approximately one third of patients had strokes. They attributed this to the intimal disruption of the greater vessels from perfusion cannulas and resultant embolization of atheromatous material. Therefore, the prevailing concern of that time when using antegrade perfusion was to significantly reduce the risk of intimal damage and prevent catheter-associated embolization or dissection by using hypothermic arrest alone.

In 1995, Sabik and colleagues ² popularized the technique of using the right subclavian/axillary artery for arterial inflow for complex cardiac surgery so that a hostile aorta did not need to be cannulated. Thus, to prevent intimal damage and to be able to flush potential embolic material out of the greater vessels, my colleagues and I ^3,4 have recommended subclavian artery side-graft antegrade perfusion with occlusion of the innominate and left common carotid arteries with balloon catheters, without tapes encircling the arteries, and deep hypothermia with electroencephalographic brain silence. We applied this approach in our prospective randomized study ^3,4 and observed that . . . [Full Text of this Article]

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J. Thorac. Cardiovasc. Surg. 2002 124: 1080-1086. [Abstract] [Full Text] [PDF]

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