ASCP: Antegrade Selective Cerebral Perfusion, CPB: Cardiopulmonary Bypass,
Hct: Hematocrit, MAP: Mean Arterial Pressure, Sd: Standard Deviation
ASCP perfusion was unilateral in 27 patients (90%) with a mean duration of 25.13 ± 19.02 minutes (range 10-53 minutes). Bilateral cerebral perfusion was instituted in 3 patients (10%) whose ASCP periods were 64, 90 and 63 minutes. One of them suffered from transient neurologic dysfunction (agitation and mild obtundation) which regressed completely and his motor function in the lower extremities was graded as 4/5 with no evidence of sensory loss (3.3%). He was discharged with no significant impairment in walking and his daily life activities. Having had a percutaneous coronary intervention 25 days ago, he received ascending and total arch replacement with distal elephant trunk formation due to chronic type I aortic dissection. During ASCP, a drop in T10 NIRS value by 34.73% at the 33rd minute was observed, and bilateral cerebral perfusion was instituted during the rest 57 minutes and the T10 NIRS value returned to 77,8% of baseline (90 minutes of ASCP). There was no significant reduction in cerebral NIRS values (7,5% and 13% reduction in his right and left cerebral NIRS values respectively). There was no other permanent neurologic deficit in any other patient.
Regarding right and left cerebral NIRS values, there was a slight decline with the onset of CPB through cross clamp application and ASCP periods in the whole group, but this difference was not statistically significant in any period throughout the operation (p<0.05). T5 and T10 NIRS values on the other hand were significantly lower than the baseline levels after cross clamp application, during ASCP and CPB termination periods (p<0.001). These values started to decrease gradually with the onset of CPB and were lowest during ASCP (Figure 1). T5 and T10 levels differed also between each other during ASCP period (55.40 ± 9.21 vs 51.07 ±12.76 respectively, p=0,001). There was a good correlation between T5 and T10 NIRS values during ASCP period (r= 0.853, p<0.001) but we could not detect any correlation between the cerebral and thoracic NIRS values during the same period (CR-T5 r=0.345, p=0.062 and CL-T5 r=0.344, p=0.062).