Retrograde systemic venous perfusion with selective jugular cannulation

: 46 patients underwent surgery for the ascending aorta and the aortic arch using continuous hypothermic retrograde systemic venous perfusion (RSVP). Good cerebral protection has been obtained by this method in most patients including four in whom periods of retrograde perfusion exceeded 90 minutes (the longest 140 min). In first 19 patients retrograde perfusion was performed through conventional caval cannulae, but one of them sustained serious neurological damage despite a relatively short duration of retrograde perfusion probably due to impediment of retrograde flow to the brain with venous valves at the jugular-subclavian junction. Then we have developed a new technique that employs a cavoatrial cannula inserted selectively into the internal jugular vein beyond the valve at the venous angle and have applied this technique in last 27 patients.