【摘 要】
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Purpose: Brain protection during aortic arch surgery is important, especially in patients with cerebral ischemia.To prolong the safe limits of conventional retrograde cerebral perfusion (RCP), Kitahor
【机 构】
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Department of Cardiovascular Surgery Kyorin University Japan
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Purpose: Brain protection during aortic arch surgery is important, especially in patients with cerebral ischemia.To prolong the safe limits of conventional retrograde cerebral perfusion (RCP), Kitahori, Kawata, Takamoto et al.assessed a novel protocol, intermittent-pressure-augmented retrograde cerebral perfusion (IPA-RCP), in a canine model.We applied this new protocol clinically in a young woman with aortitis syndrome.Intermittent-Pressure-Augmented Retrograde Cerebral Perfusion Initially, the oxygenated blood was perfused through the superior vena cava at a pressure of 15-20 mmHg.Two minutes later, the initial pressure augmented perfusion at 45 mmHg was attempted then lowered.The duration of the augmentation was 30 sec, and the perfusion pressure was then lowered to 20 mmHg.This 30 sec augmentation followed by a 2 min interval was repeated through the arch reconstruction.Intracranial regional oxygen saturation (rSO2) was measured with a TOS-96 brain oximeter (TOSTEC Co., Ltd.Tokyo, Japan).Results: The patient recovered consciousness soon after the operation with no neurological abnormalities and her postoperative course was uneventful.Postoperative brain perfusion scintigraphy showed normal right brain perfusion.Although her brachiocephalic artery and left subclavian artery were occluded, and she had a history of cerebral infarction, after total arch replacement and aortic valve replacement she recovered consciousness well and had no neurological complications.Near infrared oximetry showed recovery of intracranial blood oxygen saturation during the pressure augmentation.Our preliminary randomized comparative study in clinical cases of IPA-RCP (n=10) and standard RCP (n=10) showed that the rSO2 decline ratio 60 min after the initiation of the IPA-RCP group was 13.1±3.7% in contrast with 24.5±13.1% in RCP group (p< 0.05).Conclusion: IPA-RCP provides the "bottom raising effect" of the rSO2 and may be a more effective brain protection method compared with conventional RCP.
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