Antegrade cerebral perfusion in patients with different anatomical variants of the brachiocephalic trunk

Aim: To analyze the results of antegrade brain perfusion via the brachiocephalic trunk during hemiarch surgery in patients with variant anatomy of the brachiocephalic trunk.

Material and Methods. The retrospective study included 259 patients who underwent surgery for an ascending aneurysm. The patients were divided into two groups depending on the anatomy of the brachiocephalic trunk: with normal (n = 202) and variant vascular anatomy (n = 57). Intraoperative and early postoperative data were analyzed in patients of both groups, including an assessment of neurological and cognitive status.

Results. According to infrared spectroscopy, the level of brain oxygenation in patients of both groups did not exceed normal values during the entire operation, including the period of circulatory arrest (63–72%). In 1 (0.49%) case, a stroke developed in the group with normal brachiocephalic trunk anatomy. The incidence of delirious condition in the early postoperative period was higher in the group with normal brachiocephalic trunk anatomy – 8 (3.9%) versus 1 (1.7%) cases in the group with variant brachiocephalic trunk anatomy, but without statistically significant differences (p = 0.414). Cognitive function in the postoperative period in patients in the groups with normal and variant brachiocephalic trunk anatomy did not decrease below the normal threshold of 25 and 23 points, respectively (p = 0.11).

Conclusions. Antegrade perfusion of the brain through the brachiocephalic trunk during hemiarch operations in patients with normal and variant anatomy of the brachiocephalic trunk does not worsen cognitive status, reduces the frequency of neurological complications, thus this type of perfusion is appropriate, safe and effective.

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