Minimal safe perfusion flow of selective cerebral perfusion during deep hypot-hermic circulatory arrest
Liu Chang
Chen Yang
Zhu Xi-yu
Wang Dong-jin
Abstract：Objective To identify whether a minimal perfusion flow of selective cerebral perfusion (SCP) during deep hypot-hermic circulatory arrest ( DHCA) was still safe in the surgery of aortic dissection ( AD) patients, and to evaluate. The protective effects of it on decreasing neurological complications after surgery. Methods A retrospective analysis of 107 patients with Stanford type A aortic dissection in our center since Jan. 2016 to Dec. 2016 was performed. Patients with moderate or severe carotid artery occlusion or cranial vascular diseases were excluded by ultrasound examination. All patients enrolled were received total arch replacement and fro-zen elephant trunk implantation during surgery accompanied with DHCA and SCP. We divided all patients into two groups, M group (3 ml/(kg·min)) and D group (5 ml/(kg·min)), according to the perfusion flow. Near infrared reflectance spectroscopy (NIRS) was settled to evaluate bilateral cerebral oxygen saturation ( rSO2 ) continuously. Meanwhile, lactate levels were also recorded at several time points during surgery, such as after anesthesia induction ( T1) , after aortic cross clamp ( ACC) ( T2) , 10 min after circulatory restoration ( T3) , 10 min after ACC releasing ( T4) and 5 min after cardiopulmonary bypass ( CPB) ( T5) . Results All patients en-rolled in our study were received DHCA and SCP during operations, and none of them were suffered from severe neurological complica-tions. There were no significant differences in perfusion time, ACC time, CPB time and operation time. Also, no differences were found among lactate levels, mechanical ventilation time, intensive care unit duration and post-operative complications. We only found that the levels of rSO2 were a bit lower in M group than those in D group at T3 and T4 time points ( P<0.05) . However, the value of rSO2 in M group was still safe for patients to maintain cerebral oxygen metabolism. Conclusion It is acceptable that minimal perfusion flow( 3 ml/( kg·min) ) is still safe during DHCA. Moreover, it can provide enough flow and ensure oxygen metabolism to meet the re-quirement of cerebral protection.
Keywords：Deep hypothermic circulatory arrestAntegrade selective cerebral perfusionCerebral oxygen saturationExtra-corporeal circulation
Publication Date：2017-01-01
Online Publishing Date：2025-08-15(First online date of this platform, not the publication date of the document)
Pages：5( 204-207,227 )