Antegrade and/or Retrograde Cerebral Perfusion Policies?

Valerie,

The cerebral protection policy here in London is for antegrade cerebral perfusion through cannulation of the axillary artery. For cases that require DHCA, the surgeon makes an incision in the right shoulder and exposes the axillary artery. An 8mm graft is sewn on to the artery. No arterial cannula is used. Most surgeons put the 3/8" connector on the arterial line directly into the graft and tie it in. It is a tight fit as 3/8" = 9.5 mm - a little larger than the graft. Sometimes a small slit is made in the end of the graft to facillitate insertion of the connector. Total body perfusion is accomplished through this cannulation technique. Once the desired temperature is reached (<20oC for most surgeons but one surgeon uses 25oC) circulatory arrest can be initiated. Normally, the innominate artery is clamped, and antegrade cerebral perfusion is accomplished through the right carotid and vertebral arteries. With an entact circle of willis, this can usually provide enough cerebral blood flow at those temperatures. Depending on the repair necessary, the clamp on the innominate artery can be moved in stages to include the left sided head vessels as they are connected to the new graft.

I hope this helps. If I can be of any further assistance, please contact me at gswalsh2000@gmail.com .

Graham Walsh