The Application Of Modified Bilateral Cerebral Protection Measure To The Acute Stanford-Type A Aortic Dissection Surgery By Means Of Ascending Aorta Replacement Combined With Open Placement Of Triple-Branched Stent Graft

【Objective】To summarize the experience of cerebral protection via modified bilateral amegrade cerebral perfusion during the acute stanford-type A aortic dissection surgery by means of ascending aorta replacement combined with open placement of triple-branched stent graft.【Methods】From July 2009 to January 2011, 40 patients with Stanford-Type A aortic dissection ,who underwent surgery during deep hypothermia circulatory arrest(DHCA), and modified bilateral antegrade selective cerebral perfusion using the right axillary artery and the left common carotid artery, by Means of Ascending Aorta Replacement Combined With Open Placement of Triple-Branched Stent Graft,were studies..【Results】Mean cardiopulmonary bypass time was 201.65±35.99 minutes(range 151 to 309 minutes).Mean aortic cross-clamp time was 90.05±17.57 minutes(range 64 to 150 minutes ).Mean low-flow cerebral perfusion time was 35.55±6.57 minutes(range 20 to 49 minutes),and mean circulatory arrest time was 4.96±2.08 minutes(range 2 to 11 minutes);respectively. The postoperative wake time and duration of intensive care unit stay were 5.82±1.01 h(range 3.75 to 8.50 hour)and 63.32±18.26 h(range 34 to 120 hours),No patient died, but two had transient neurologic deficit(TND), recovering before admission .No permanent brain damage was found.【Conclusions】The described bilateral cerebral perfusion technique may be the optimal method for brain protection during the acute stanford-type A aortic dissection surgery by means of ascending aorta replacement combined with open placement of triple-branched stent graft. It can prevent ischemia injury in brain after operation and improve the clinical outcomes.