T. Takeichi et al.: J Extra Corpor Technol 2025, 57, 153--159 155 Figure 2. Mechanism of NIRO-200NX.( a) When oxygenation is insufficient, there is no observable change in the inflow of hemoglobin to the brain( nTHI, DcHb); however, DO 2 Hb decreases, while DHHb increases conversely.( b) In cases of congestion, the total hemoglobin volume( nTHI, DcHb) increases alongside the rise in DHHb in the brain.( c) In ischemic conditions, the inflow of hemoglobin to the brain( nTHI, DcHb) decreases.
At a rectal temperature of 30 ° C, circulatory arrest was established, PF ceased, and retrograde cerebral perfusion( RCP) initiated. During RCP, cerebral TOI and DO 2 Hb decreased, while DHHb levels rose. Upon initiating selective cerebral antegrade perfusion( SCP), cerebral TOI and DO 2 Hb improved, and DHHb levels normalized( Fig. 3a). Radial mABP discrepancies resolved during SCP( Fig. 4). SCP was maintained with a flow rate of 800--900 mL / min, radial mABP of 32--40 mmHg, and an LCCA perfusion pressure of 30 mmHg. The heat exchanger for the cerebral perfusion line was set at 20 ° C. Cardiac arrest was achieved with retrograde cold blood cardioplegia by using glucose-insulinpotassium( GIK) solution( the ratio of blood 4: crystalloid 1), re-dosed( the ratio of blood 5: crystalloid 1) every 30 min.
The descending aorta was replaced with a 24 mm J-graft( Japan Lifeline or Triplex, Terumo Corporation, Tokyo, Japan). Circulation was restarted, and rewarming commenced. RCP, SCP, and circulatory arrest durations were 2, 21, and 27 min, respectively. Post-rewarming arterial lactate levels were 3.6 mmol / L. The Bentall procedure was completed using a 21 mm INSPIRIS RESILIA aortic valve( Edwards Lifesciences, Irvine, CA, USA). CPB was weaned uneventfully, with total CPB and aortic cross-clamp times of 198 and 161 min, respectively.
The patient’ s postoperative course was uneventful. She was discharged on postoperative day 26 following a two-day intensive care unit stay.
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