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J Thorac Cardiovasc Surg 2002;123:581-582
© 2002 The American Association for Thoracic Surgery

Letters to the Editor

Impact of the duration of adjunctive hypothermic circulatory arrest on neurologic outcome with antegrade cerebral perfusion

Teruhisa Kazui, MD, Abul Hasan Muhammad Bashar, MBBS, Naoki Washiyama, MD

First Department of Surgery
Hamamatsu University School of Medicine
1-20-1, Handayama
Hamamatsu, Japan

To the Editor:

We read with great interest the recent article in the Journal by Hagl and colleaguesGo 1 titled, "Neurologic Outcome After Ascending Aorta–Aortic Arch Operations: Effect of Brain Protection Technique in High-Risk Patients."

We basically agree with the conclusion drawn by the authors regarding the superiority of antegrade cerebral perfusion (ACP) for aortic reconstruction procedures that are likely to require more than a 40-minute interruption of the cerebral circulation. The article specifies that total cerebral protection time (TCPT), in case of ACP, is equal to hypothermic circulatory arrest (HCA) time plus the ACP time. However, it does not clearly mention the duration of protection provided by HCA alone, when applied as an adjunct to ACP. It appears that both before the initiation of ACP and when it had to be temporarily suspended, HCA was the only method of protection. The duration of this time may be an important factor influencing the incidence of neurologic events. If this time exceeds 40 minutes, an increased incidence of neurologic complications can be expected and ACP may have little to do with this increased incidence. With our technique of ACP, brain protection times of less than 80 minutes have been associated with neurologic dysfunction, both temporary and permanent, of less than 5%.Go 2 However, when the TCPT exceeds 80 minutes, the neurologic complication generally increases irrespective of the method of protection being used.

About the total perfusion volume, the authors mention a rate of 800 to 1200 mL/min. In our opinion, a volume in the vicinity of 1000 mL/min may be excessive in a situation in which a profound hyperthermia of 10° to 13°C has been induced. Since the patient's body weight is a useful parameter for the determination of perfusion volume, it would be more meaningful if the authors would provide the perfusion volume per kilogram of body weight per minute.

12/8/121502doi:10.1067/mtc.2002.121502

References

  1. Hagl C, Ergin MA, Galla JD, Lansman SL, McCullough JN, Spielvogel D, et al. Neurologic outcome after ascending aorta– aortic arch operations: effect of brain protection technique in high-risk patients. J Thorac Cardiovasc Surg. 2001;121:1107-21.[Abstract/Free Full Text]
  2. Kazui T, Washiyama N, Bashar AHM, Terada H, Yamashita K, Takinami M. Improved results of atherosclerotic arch aneurysm operations with a refined technique. J Thorac Cardiovasc Surg. 2001;121:491-9.[Abstract/Free Full Text]




This Article
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Right arrow Author home page(s):
Teruhisa Kazui
Abul Hasan Muhammad Bashar
Right arrow Permission Requests
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Right arrow Articles by Kazui, T.
Right arrow Articles by Washiyama, N.
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PubMed
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Right arrow Articles by Kazui, T.
Right arrow Articles by Washiyama, N.
Related Collections
Right arrow Lung - cancer
Right arrow Cerebral protection

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