Comparative Experimental Srudy of Cerebral Protection during Aortic Arch Reconstruction

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Retrograde cerebral perfusion (RCP), selective cerebral perfusion (SCP) and hypothermic circulatory arrest (HCA) were compared in terms of their effect on cerebral fumction of dogs as evaluated by somatosensory evoked potentials (SEP). Nineteen mongrel dogs were divided into three groups and subjected to RCP (n=8), SCP (n=6) and HCA (n=5) for 90 minutes. Brain temperatures were held at 20ﾟC and then rewarmed gradually to normal temperature. SEP completely disappeared as soon as RCP or HCA started and never recovered except one case in the HCA group. However SEP reappeared in five cases out of eight in the RCP group, the amplitude was below 50% of normal. In the SCP group, it recovered in all cases. Only 2% of cerebral blood flow (CBF) and about 3% of cerebral metabolic rate for oxygen (CMR02) were obtained during RCP compared to pre-operation value. The analysis of cerebral tissue ATP and water content supported these results. RCP had some advantage for cerebral protection compared with HCA,but could not supply sufficient CBF to maintain brain function. SCP was the safest method in arch reconstruction that requires cerebral protection for 90 minutes.