Técnica de perfusión selectiva cerebral vía subclavia para la corrección de patologías del arco aórtico / Selective cerebral perfusion technique by subclavian approach for correction of aortic arch pathology

RESUMEN

Objetivo: describir y evaluar la técnica de perfusión subclavia para protección cerebral selectiva con hipotermia moderada.Métodos: estudio descriptivo de 19 pacientes, a quienes se les practicó corrección de disección o aneurisma del arco aórtico mediante la utilización de esta técnica...

ABSTRACT

Objective: describe and evaluate the subclavian perfusion technique for selective cerebral protection with moderate hypothermia. Methods: descriptive study of 19 patients to whom correction of the dissection or aneurysm of the aortic arch through the utilization of this technique was practiced. Results: between September 2002 and September 2005, 19 patients were operated. 68.4% were men with mean age 54.05 ± 13.53 years. 57.8% corresponded to aortic dissection type A; the remaining 42.2% had aneurysms in some portion of the aorta, with arch involvement. 73.7% had aortic valve insufficiency. 47.3% were in functional class I, 31.5% in class II and 21% in class III. 36.8% required coronary revascularization. Mean time of selective cerebral perfusion was 28.95 ± 8.73 minutes; systemic perfusion was 163.31 ± 32.15 minutes; aortic clamping was 135.36 ± 34.48 minutes and mean temperature was 27.66° ± 0.94°C. There were 3 deaths. No definitive neurological complications were found.Conclusions: this technique may be standardized for elective or emergent surgeries. It is a simple reproducible technique that allows more prolonged periods of time for the reconstruction of the aortic arch without producing cerebral ischemia; the extracorporeal circulation times are shorter, there are few bleeding complications, there is a decrease of cerebral anterograde embolism, and an excellent neurological result.