Does retrograde cerebral perfusion via superior vena cava cannulation protect the brain?

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Serval ID
serval:BIB_D1C6E8B5B6F3
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Does retrograde cerebral perfusion via superior vena cava cannulation protect the brain?
Journal
European Journal of Cardio-Thoracic Surgery
Author(s)
Kunzli  A., Zingg  P. O., Zund  G., Leskosek  B., von Segesser  L. K.
ISSN
1010-7940
Publication state
Published
Issued date
12/2006
Peer-reviewed
Oui
Volume
30
Number
6
Pages
906-9
Notes
Journal Article
Research Support, Non-U.S. Gov't --- Old month value: Dec
Abstract
OBJECTIVE: The retrograde cerebral perfusion via cannulation of the superior vena cava is a widespread method for optimising protection of the brain during hypothermic circulatory arrest. METHODS: In 14 cadavers (8 females, 6 males) of the local department of pathology, an examination was performed to check the competence of the valves of the internal jugular veins. After a complete preparation of the superior vena cava, the innominate vein and both internal jugular veins, ligating all side branches, a retrograde perfusion on 7 cadavers was installed, documenting flow and pressure of each internal jugular vein (IJV) in vitro. Afterwards, the veins were opened and their valves inspected. RESULTS: In all 14 cadavers, anatomically and functionally competent valves on the right proximal IJV were found. Only 1/14 cadaver had no valve in the left proximal IJV. Additional rudimentary and incompetent valves could be identified in 1/14 cadaver on the distal right IJV, and in 2/14 cadavers on the left IJV. Retrograde flow measurement of 7/14 cadavers revealed 0 ml/min in 4/7 cadavers, 6 ml/min in 1/7, 340 ml/min in 1/7 and 2500 ml/min in 1/7 cadaver. CONCLUSIONS: As a rule, anatomically and functionally competent valves in the proximal IJV are present. In human beings, they obstruct the direct retrograde inlet to the intracranial venous system, which suggests an unbalanced and unreliable perfusion of the brain. Therefore, retrograde cerebral perfusion by cannulating the superior vena cava may help flushing out embolism and supporting 'the cold jacket' of the brain. However, its effect of retrograde backflow cannot be a sign of adequate cerebral perfusion.
Keywords
Brain Ischemia/*prevention & control *Cardiopulmonary Bypass Catheterization/methods *Cerebrovascular Circulation Female Humans Hypothermia, Induced Jugular Veins/anatomy & histology/*physiology Male Models, Neurological Perfusion/methods Vena Cava, Superior
Pubmed
Web of science
Open Access
Yes
Create date
14/02/2008 14:18
Last modification date
25/09/2019 6:10
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