[[700 Technical Outline of Repair of Aortic Dissection]] # Cerebral perfusion ## Favored Alternative: Retrograde Cerebral Perfusion[^a] - Prior to beginning the circulatory arrest period - Preferably during the cooling period - Prepare to exclude SVC - Develop a plane behind the SVC above the right pulmonary artery - Pass an umbilical tape behind the SVC, and pass through a Rumel, clamp loosely with a Kelly - Cannulate SVC with Retrograde Cardioplegia Cannula - If necessary, free some SVC from underneath the pericardial reflection with a Metzenbaum - Create a small (5mm on a side) diamond cannulation stitch in the SVC a centimeter above the umbilical tape using an unpledgeted 4-0 prolene, pass through a Rumel, clamp with a Kelly - Prepare a Cerebral Perfusion line from the Arterial Cannula - Hook up an Octopus multi-branched distribution system to the de-airing line off the arterial cannula (currently clamped). Make sure all of the branches of the Octopus are clamped. - During Circulatory Arrest - Stab center of cannulation in SVC with 11 blade - Insert retrograde cardioplegia catheter into SVC without stylet, directing tip 2-3 cm towards head - Clear air from the line, clamp integral clip - Cinch umbilical tape down - Clamp arterial cannula, unclamp de-airing limb, flush blood through octopus, keeping one limb open - Attach to retrograde cannula in SVC, release integral clips allowing flow into SVC - Keep perfusion pressure 20-25 mmHg, not to exceed 30 mmHg, with resulting flows anywhere from 200-400 cc/min [^a]: See [[Other Options for Cerebral Perfusion]]