Surgery for Aneurysm of the Proxymal Aorta Using Cool Head-Warm Body Perfusion

Abstract

Hypothermic cerebral perfusion is one of the commonly used methods for cerebral protection in aortic arch surgery. To reduce the adverse effects caused by hypothermia, we used a modified selective cerebral perfusion technique, called cool head-warm body perfusion, during the period from January 1990 to March 1999, for 61 patients with aneurysm of the ascending aorta or aortic arch who underwent aortic repair using selective cerebral perfusion. Three perfusion techniques were used, differentiated by body temperature: deep hypothermia (nasopharyngeal temperature of 20°c, n=14) (DH group), moderate hypothermia (nasopharyngeal temperature of 28°c, n=17) (MH group), cool head-warm body (nasopharyngeal temperature of 25°c and bladder temperature of 32°c, n=30) (CHWB group). The three groups were compared in terms of duration of cardiopulmonary bypass and operation, intraoperative blood loss, and operative outcome. Operation and rewarming time was significantly shorter in the CHWB group than in the other groups. Cardiopulmonary bypass time was significantly shorter in the CHWB group than in the DH group. Blood loss was significantly less in the CHWB group than in the DH group. Postoperative awakening time was significantly shorter in the CHWB group than in the other groups, and postoperative intubation time was significantly shorter in the CHWB group than in the DH group. Hospital mortality was 14% in the DH group, 12% in the MH group, and 7% in the CHWB group. Stroke occurred in one patient in each group (7% for DH, 6% for MH, 3% for CHWB). No difference was observed in the rate of hospital mortality or stroke. These data suggest that cool head-warm body perfusion in aortic surgery is a useful and safe technique.