Total Arch Replacement Under Flow Monitoring During Selective Cerebral Perfusion Using a Single Pump

BACKGROUND: Flow in individual vessels is passively determined when a single pump is used for selective cerebral perfusion during aortic arch surgery. We installed a Doppler flowmeter in the circuit and measured flow in the supraaortic vessels to determine flow distribution during selective cerebral perfusion.

METHODS: We cannulated and perfused three supraaortic vessels using a single pump in 203 patients who underwent elective (n = 158) or emergency or urgent (n = 45) total arch replacement using a four-branched prosthetic graft. Flow rates in each branch were continuously monitored during selective cerebral perfusion.

RESULTS: The respective mean flow rates in the brachiocephalic, left common carotid, and left subclavian arteries and total flow rates were 5.8, 3.3, 3.4, and 12.5 mL·kg(-1)·min(-1). The ratios of flow in these vessels to total flow were 46.5%, 26.5%, and 27.0%, respectively, and they were not affected by the total flow rate. In-hospital mortality rates among the patients who underwent elective and emergency or urgent surgery were 1.9% (n = 3) and 11.1% (n = 5), respectively, and the rates of postoperative stroke were 2.5% (n = 4) and 8.9% (n = 4), respectively. Total flow in the supraaortic vessels during selective cerebral perfusion was significantly lower in patients with neurologic complications than in those without (732 versus 806 mL/min; p = 0.034).

CONCLUSIONS: Flow monitoring showed that selective perfusion using a single pump adequately distributed flow among all supraaortic vessels. This monitoring system might help to improve brain protection and outcomes during total aortic arch replacement.