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).