The Novel Techniques Of Extracorporeal Circulation In Total Aortic Arch Replacement

Objective: The aims of this study are as follows: firstly, to compare the cerebral protection effect of unilateral and bilateral antegrade selective cerebral perfusion during total aortic arch replacement; secondly, to evaluate the outcome of patients with novel techniques during cardiopulmonary bypass.Methods: From June 2003 to March 2004, 16 patients who underwent total arch replacement were randomisedly allocated to one of two methods of brain protection: unilateral (unilateral group, n=8) or bilateral antegrade selective cerebral perfusion (bilateral group, n=8). During the CPB, the following novel strategies were employed: venous blood-letting, total colloid priming, double/triple arterial lines with single pump head, modified pH-stat combined with alpha-stat, hyperoxia management during deep hypothermia, steady cooling & rewarming and cold reperfusion. Preoperative and postoperative neurological examination, brain CT scan, and cognitive function tests were performed. During the operation, the pressure in innominate artery and left common carotid artery was monitored. Blood gas samples were drawn from membrane oxygenator as well as from jugular venous bulb. Serum 100 protein was assayed before skin incision, immediately after thoracotomy, 30 minutes after the cardiopulmonary bypass, as well as 6 hours, 24 hours and 48 hours after the operation.Results: 1, All patients survived the operations and were discharged from hospital. No new brain infarction occurred. Transient Neurologic Dysfunction...