2.Retrograde cerebral perfusion (RCP)
This technique was first described by Ueda (23) and aims at prolonging
the safe duration of HCA, flushing embolic debris and air out of the
brain vessels and removing toxic metabolites. A few years later it was
demonstrated in different animals that RCP does not result in effective
cerebral perfusion (24,25): RCP does not provide adequate nutritive
delivery to meet cerebral metabolic demands. Also Ehrlich demonstrated
ineffective cerebral flow during RCP (26). Despite the lack of any
benefit in outcome using RCP, some surgeons still today use it
throughout their aortic arch replacements because some large clinical
series demonstrated good results (27). On the other hand the group of
Birmingham UK could not demonstrate a cerebral metabolic, neurologic of
neuropsychological outcome benefit using RCP related to arch surgery
(28,29). A potential disadvantage is increasing brain oedema
exacerbating cerebral injury (30). RCP seems to be fading away gradually
nowadays.