1. 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
   • AGE
   • 65+/-11
   Male 72
   • Female
   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
   • Redo
   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
   • Brain perfusion time/min
   • Overall hospital Mortality
   TransientNeurologic deficit
   • Permanent Neurologic defici t
   106 2 191 +/- 53
   • 35 +/- 16
   8%*