Impact of Isolated Cerebral Perfusion Technique for Aortic Arch Aneurysm Repair in Elderly Patients

In aortic surgery, a severely atherosclerotic aorta is a known risk factor for perioperative stroke. The authors adopted a novel procedure of selective cerebral perfusion, named isolated cerebral perfusion (ICP), for the prevention of stroke during aortic arch operations. Between January 2010 and June 2016, 48 patients (mean age, 80 ± 3 years) at Yokohama City University Medical Center, Yokohama, Japan underwent total aortic arch replacement, which included nine emergency cases with rupture. ICP was routinely performed for extracorporeal circulation during total arch replacement. The ICP procedure included the following steps: First, 9-mm Dacron grafts were anastomosed to the bilateral axillary arteries for systemic perfusion. Next, the left common carotid artery (LCCA) was clamped just before starting systemic perfusion. Dissection of the LCCA and insertion of a balloon-tipped cannula into the LCCA were performed. Extracorporeal circulation through the bilateral axillary arteries and selective cerebral perfusion to the LCCA were simultaneously started. Finally, at a bladder temperature of 25°C, clamping of the brachiocephalic and left subclavian arteries was performed. Preoperative evaluation by enhanced computed tomography confirmed that 62.2% of patients had severely atherosclerotic aortas and 37.8% had shaggy aortas. The overall 30-day mortality rate was 2.1%, whereas that for elective cases was 0%. Neurologic deficits developed in 3 patients (6.3%), 1 patient (2.6%) after an elective procedure. The 1-year and 3-year survival rates were 85.3% and 69.5% overall and 87.0% and 70.4% in elective cases, respectively. ICP during total aortic arch replacement presents an acceptable procedure for elderly patients with severely atherosclerotic aortas.