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- 1. SAFETY OF ANTEGRADE CEREBRAL UNILATERAL PERFUSION IN AORTIC
ARCH SURGERY C.Cavozza, P.Scoti, A.Audo, D. Mercogliano, M. Serra,
P. Spitaleri, G. Camporini, C. Manca, D. Ricci,G. Parodi, L. De
Silva,A. Pergolo andD. MediciCardiac Surgery and CardiacAnesthesia,
AziendaOspedaliera Alessandria, Italty
Male 72
36 Elective 36 Emergency 72 Emergency Elective ? Andthe brain?
Surgical Procedures Direct orside-graft Innominate artery
cannulation Chronic typeA Aortic Dissection Annuloectasia involving
ascending hemiarch Ascending aortic aneurysm involving ascending
hemiarch
Bentall with ascending hemiarch replacement 5 Asacending aorta and
hemiarch replacement 4 5* Bentall with total arch replacement and
TSA reimplantation 3 8 11 Davidwithpartial arch replacement5 Cabrol
with total arch replacement and TSA reimplantation 3 Ascending
aorta with total arch replacement and TSA reimplantation with
Elephant trunk 2 Elective Surgical Procedures Emergency Surgical
Procedures Type AStandford aortic dissection or De Bakey I/II Redo
Bentall with Ascending hemiarch replacement 16 Ascending aorta and
ascending hemiarch replacement 51 6 Wheat andhemiarch replacement 3
Ascending aorta and total arch replacement and TSA reimplantation
with elephant trunk 2 SITES OF ARTERIAL CANNULATION DURING CPB
Brain Perfusion during circulatory arrest 24 patients 14 patients
Patients were cooled to26 Cof rectal temperature .
Rigthantegradeperfusionstarted at flow rate of 10-15 cc/Kg/min with
an brain inflow temperature of 25 C When arch and Femoral artery
are cannulated a Coronary sinuscatheter is inserted into innominate
artery for brain perfusion To asses brain perfusion we used
infrared spectroscopy scalp capillary saturation by a dual sensor
for NIRSAttached to the patient's forehead to monitor the tissur
oxygenation index (TOI) in the bilateral frontal lobe. Anesthesia
was maintaned by continous intravenous propofol, remifentanyl and
cis-atracurium infusion. The Bispectral index (BIS) was monitored
with BIS monitor to mantain the depth of anesthesia. The BIS index
was maintained from 35 to 45 at the beginning and from 0 to 20
during circulatory arrest ( Bust Soppression), to reduce cerebral
oxigen demand (CMRO2) NIRS
- Unilateral brain perfusion
Bilateral brain perfusion CPB time/min
- Overall hospital Mortality
TransientNeurologic deficit
- Permanent Neurologic defici t
106 2 191 +/- 53
8%*