Cerebral and Systemic Perfusion
Extracorporeal circulation and cerebral antegrade perfusion are performed using a homemade, 4-branched perfusion circuit (Figure 2). It consists of four branches of the same diameter driven by a single pump LSA, LCA, brachiocephalic artery and prosthetic branch for systemic perfusion. Perfusion is kept at full flow for CPB and it redistributes depending on physiological systemic resistance. When the brachiocephalic artery is clamped, the flow is lowered to 10—12 mL/Kg/min for isolated cerebral perfusion. After the circulatory arrest time the full flow was restarted via prosthetic side branch and single cerebral vessels.