Intermittent Pressure Augmented Retrograde Cerebral Perfusion
Having an experimental finding that intermittent pressure augmented RCP (IPA-RCP) significantly reduced postoperative brain damage in a canine model, we utilize IPA-RCP in clinical settings. IPA-RCP requires intermittent augmentation of superior vena caval pressure up to 45 mmHg every thirty seconds, while conventional RCP (C-RCP) continuous pressure of 15 mmHg. We examined the impact of IPA-RCP on the outcome of aortic arch surgery. Methods Since January 1999, we have had seventy-seven operations of total arch replacement via midsternal incision, excluding cases of emergency, active infection or with any history of cer-ebrovascular events. We retrospectively compared 45 patients undergoing C-RCP from January 1999 to April 2002 with 36 patients undergoing IPA-RCP from May 2002 to December 2006. Univariable and multivariable analysis were performed to examine statistically about the incidence of neurological morbidity, that is, delayed awakening, stroke and postoperative delirium.