Abstract
Introduction. There are different modalities for brain protection in aortic arch surgery. The most safe way is
antergrade brain perfusion straight throughout brachyocephalic vessels or unilateral throughout right subclavia
artery. But till now there no evidence reading advantages and disadvantages of each method. Purpose:
compare the results of bigemispheral and unilateral cerebral perfusion in aortic arch surgery.
Material and methods. In a period from 1998 to 2014 111 patients underwent aortic arch reconstruction with
antergrade cerebral perfusion because of aortic aneurism. Mean age was 51+11.6 years, 75.7% patients were
male. Patients were divided into two groups: the first (n=63) with straight bigemispheral brain perfusion
throughout brachicaphalic vessels, the second (n=48) with perfusion throughout right subclavia artery.
Neuromonitoring parameters, neurological deficits and mortality were analyzed.
Results. Overall morbidity was 14.4%, in the first group - 14.3%, the second - 14.6%. Postoperative neurological
transient deficit was seen in 20.6% in the first group and in 6.3% in the second group. Time of cerebral
perfusion was significantly less in the second group (51+13 vs 77+22 min, p<0.05). There were no difference
in lactate level, venosus blood saturation, mean lineal blood flow speed in media cerebral artery.
Conclusion. Antergrade brain perfusion is a safe method for brain protection in aortic arch surgery. The use
of unilateral perfusion throughout subclavia artery simplifies performing arch reconstruction and decreases
risk of neurological complications.
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