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J Thorac Cardiovasc Surg 2003;126:631-633
© 2003 The American Association for Thoracic Surgery

Editorial

Retrograde cerebral perfusion: more risk than benefit?

^a From the Department of Anesthesiology and Perioperative Medicine, University Hospital Campus—London Health Sciences Center, University of Western Ontario, London, Ontario, Canada

Received for publication February 10, 2003; accepted for publication March 4, 2003.

^* Address for reprints: John M. Murkin, MD, FRCPC, Department of Anesthesiology and Perioperative Medicine, University Hospital Campus—London Health Sciences Center, University of Western Ontario, London, Ontario, N6A 5A5, Canada
jmurkin@uwo.ca

The first 300 words of the full text of this article appear below.

See related article on page 638.

 

In this issue of the Journal, Harrington and colleagues¹ have taken an important clinical step in assessing cerebroprotective strategies for patients undergoing hypothermic circulatory arrest (HCA). Prospective randomization of patients into groups to undergo either HCA or HCA with retrograde cerebral perfusion (RCP) and inferior vena caval occlusion (IVCO) by using changes in serial performance on a standardized and sensitive preoperative and postoperative cognitive test battery as the primary outcome measure was unable to show any superiority of RCP for cerebral protection. In fact, their results indicated that there might be some incremental disadvantage to RCP. At 6 weeks, patients undergoing RCP had significantly lower scores on 2 separate cognitive tests, whereas at 12 weeks, their overall standardized cognitive test scores (z scores) were lower than those of patients treated with HCA alone, suggesting greater overall cognitive dysfunction.

Although there are significant limitations to the current study as acknowledged by the authors, including the sample size of only 38 patients, the relatively short 30-minute duration of HCA, and the approximately 15% and 20% drop-out rates of apparently well patients at the follow-up testing intervals, several important messages can be identified. First, the incidence of cognitive dysfunction after HCA is not improved and might be marginally worsened by RCP. This is in accordance with the results of several other clinical trials, however. In a nonrandomized study Reich and coworkers² performed preoperative and postoperative cognitive testing on 56 patients undergoing HCA, of whom 12 patients underwent RCP. Memory dysfunction and the overall incidence of cognitive dysfunction had strong associations with RCP, even when controlling separately for age and cerebral ischemia time, suggesting worsened outcome with RCP. Okita and colleagues³ separately evaluated 60 patients who were nonrandomized but were sequentially stratified to receive either RCP . . . [Full Text of this Article]