Assessment of cerebral blood flow with transcranial Doppler in right brachial artery perfusion patients.

Background: Antegrade selective cerebral perfusion as a method of cerebral protection during the correction of aortic arch aneurysms and dissections is considered as a safe method for cerebral protection. There are still some questions remaining to be answered; such as whether cerebral perfusion through contralateral hemisphere is adequate.

Method: Fifteen consecutive patients (mean age of 53 +/- 3.3 years) underwent surgical reconstruction of aortic arch with antegrade selective cerebral perfusion through the right brachial artery. We monitored maximum, minimum and mean blood flow velocities of bilateral middle cerebral arteries using the transcranial Doppler technique at four different time periods: after induction of anesthesia, during cardiopulmonary bypass, during antegrade selective cerebral perfusion, and after termination of cardiopulmonary bypass. We compared the results of brachial cannulation group with aortic group.

Results: Following induction, no significant differences were observed in the right and left middle cerebral artery blood flow velocity measurements in and between the groups. During cardiopulmonary bypass, V(max) and V(mean) decreased significantly in both groups. When two groups were compared there was a significant decrease in the left V(max) values of brachial group (p = 0.048). In-group comparisons revealed that V(max) values were lower in left middle cerebral artery than right middle cerebral artery in brachial group (p = 0.002). With the initiation of antegrade selective cerebral perfusion in brachial group, significant decrease occurred in V(max) and V(mean) when compared with cardiopulmonary bypass values. When left and right sides were compared, although V(min) values remained similar, V(max) and V(mean) values decreased significantly in the left side (p = 0.001 and p = 0.003, respectively). After cardiopulmonary bypass, in both groups, all values restored to initial values and indicated no difference between left and right middle cerebral artery in the groups as well as between the groups. No neurologic deficit was observed in any patient postoperatively.

Conclusions: Antegrade selective cerebral perfusion through the right brachial artery, as a method of cerebral protection for aortic arch repair, seems to provide adequate perfusion for both right and left cerebral hemispheres.