Abstract

Background: During the past ten years, deep hypothermic circulatory arrest and retrograde cerebral perfusion have been used as intraoperative cerebral protection techniques during aortic arch repair. Due of some detrimental effects of these techniques, in recent years, the use of selective antegrade cerebral perfusion (ACP) technique has gained popularity.

Methods: The ACP technique is a more accepted physiological solution, while the cerebral complication rates of ACP differ widely due to the different techniques used (e.g., cannulation of the arch vessels, subclavian artery or axillary artery via direct or various graft types). The use of right brachial artery for arterial cannulation provides technical simplicity, minimizes the risk of embolization and provides better surgical exposure due to the absence of cannulas and lines in the surgical area. When the temperature reaches 26-28 °C, the cross-clamp on the ascending aorta is removed. Then the innominate and the left common carotid artery are clamped with vascular clamps and the flow of the arterial return through the upper brachial artery cannula is is decreased to 500 to 600 mL/kg/min (8 to 10 mL/kg per minute). With this technique, all distal anastomoses and aortic arch repairs are performed with a low flow and without any interruption in the flow.

Conclusion: Aortic arch repair via the right brachial artery with the use of low-flow antegrade selective cerebral perfusion is a simple and a safe technique with excellent neurologic results. It can be used for the vast majority of aortic aneurysms and dissections.