“Shaggy Aorta Protocol" - Early Institutional Experience with Retrograde Cerebral Perfusion in Open Aortic Arch Repair for Washout of Thromboembolic Debris
Christian V. Ghincea, Muhammad Aftab, Yuki Ikeno, Gavriel F. Roda, Devon A. Anderson, Leighton McCabe, Jessica Rove, Jay D. Pal, Joseph C. Cleveland, David A. Fullerton, T. Brett Reece.
University of Colorado, Aurora, CO, USA.
BACKGROUND: Despite advances in neuroprotective strategies for open aortic arch surgery utilizing hypothermic circulatory arrest, stroke related to propagation of thromboembolic and atheromatous debris persistently remains a potentially devastating complication of these operations. At our institution, we have recently begun to employ a strategy of administering a brief period of retrograde cerebral perfusion at the conclusion of hypothermic circulatory arrest (HCA) with selective antegrade cerebral perfusion (SACP) to washout any possible debris. We present our early experience utilizing this technique. METHODS: In 2019, five patients with atherosclerotic or thromboembolic burden in the aortic arch or branch vessels underwent hemiarch or total aortic arch replacement with “shaggy aorta protocol". Patient characteristics are summarized in Table 1. Patients underwent median sternotomy with right axillary or innominate arterial and dual stage venous cannulation for cardiopulmonary bypass. After cooling to moderate hypothermia, HCA was initiated with SACP maintained through the arterial cannulation site for the reconstruction of the distal anastomosis. At near anastomotic completion, a 5-minute period of retrograde cerebral perfusion was administered through a cannula in the SVC. Patients were rewarmed and weaned from bypass uneventfully.
RESULTS: None of the five patients developed postoperative neurologic deficits, despite their high-risk aortic pathologies. All patients were discharged in good condition.
CONCLUSIONS: In conclusion, our early experience utilizing a strategy of retrograde cerebral perfusion for the washout of potential arterial thromboembolic debris as an adjunct in aortic arch repair with HCA and SACP shows promising results with no cerebrovascular complications.
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