RU2734136C1 - System and method for selective bilateral perfusion of cerebrum in reconstructive operation on aortic arch performed in conditions of artificial circulation - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: group of inventions refers to medicine, namely to cardiovascular surgery and medical equipment. System for selective bilateral cerebral perfusion comprises a cardiotomeric reservoir, a first pump, an oxygenator, the output of which is connected to the arterial main line port. System also includes a circulation tank, a heat exchanger, a portal of the lCCA, a portal of the BCT, the second and third pumps, the first, the second and the third pressure sensors, six three-way breathing system connectors. Output of the oxygenator is connected in series to the portal of the arterial main line through a first three-way breathing system connectorand the first pressure sensor, one of the ports of the first three-way breathing system connector is connected to the first portal of the second three-way breathing system connector, which in-series connects the inputs of the circulation tank and heat exchanger. Heat exchanger portal via third tee is connected with ports of lCCA and BCT by individual lines, one of which comprises second pump and second pressure sensor, and another one - third pump and third pressure sensor, wherein outlet of circulation tank is communicated via fourth, fifth and sixth three-way breathing system connectors with lCCA and BCT lines. Method of selective bilateral of cerebrum perfusion is performed by means of the declared system.

EFFECT: group of inventions enables reducing the number of neurological complications ensured by prolonged cerebral hypothermia at the stage of patient's warming, control of perfusion rate and pressure in arteries of each cerebral hemisphere.

2 cl, 1 tbl, 1 ex, 3 dwg

Description

The group of inventions relates to medicine, namely to cardiovascular surgery, medical equipment, can be used when performing operations on the aortic arch and its branches, carried out in conditions of hypothermia and circulatory arrest with pharmaco-cold cardioplegia.

Reconstructive operations on the aortic arch are performed in conditions of circulatory arrest with isolated cerebral perfusion. Antegrade mono- or bighemisferal cerebral perfusion is the "gold standard" for maintaining blood circulation in the brain.

The American College of Cardiology (ACC) and the American Heart Association (AHA) guidelines for the diagnosis and treatment of patients with aortic pathology have identified these methods of protecting the brain and internal organs as optimal in aortic surgery (Class IIa, Level evidence B) (Belov Yu.V., Charchyan E.R., Axelrod B.A., Guskov D.A., Fedulova S.V., Eremenko A.A., Skvortsov A.A., Khachatryan Z.R ., Medvedeva L.A., Oistrakh A.S. Protection of the brain and internal organs during reconstructive interventions on the aortic arch: features of intraoperative tactics and monitoring. Circulatory pathology and cardiac surgery. 2016; 20 (4), pp. 34-44) ...

A system and method of cerebral antegrade perfusion of the brain during reconstructive operations on the aortic arch are known, which involve individually controlled and regulated cerebral and visceral perfusion under conditions of mild hypothermia (RU 2670006, C1).

However, the known method does not provide for the control of the volumetric perfusion rate in isolation in the arteries of each hemisphere of the brain, and also does not allow to accurately estimate the perfusion pressure in the brachiocephalic trunk (BCS) and the left common carotid artery (VOCA). After removing the circulatory arrest, pressure control in the BCS and VOCA is possible only with the help of an occluder on the cerebral perfusion line. The scheme does not allow for separate monitoring and correction of the temperature of the patient's brain and body.

In addition, the method is complex, since it requires ultrasound Doppler sonography of the BCS, LOSA, the left axillary artery, as well as transcranial Doppler sonography of the middle cerebral artery (twice).

As a prototype, we have chosen a system and method for selective cerebral perfusion of the brain during circulatory arrest during reconstructive operations on the aortic arch, (Selective Antegrade Cerebral Perfusion Attenuates Brain Metabolic Deficit in Aortic Arch Surgery: A Prospective Randomized Trial DK Harrington, AS Walker Kaukuntla, RM Bracewell, T. N. Clutton-Brock, M. Faroqui, D. Pagano, and RS Bonser. Circulation. 2004; 110: 11-231-11-236), the essence of which is as follows.

In the known prototype system, between the cardiotomy reservoir and the oxygenator through a 10 mm line with a silicone fragment installed in the first pump, the arterial line of the physiological unit leaves, into which the arterial filter is implanted; then a tee 3 / 8-3 / 8-1 / 4 is installed, and a 6 mm line with a silicone fragment is connected to it, which is installed in the second pump. The system is filled with perfusate and before circulatory arrest on the operating table, a 1 / 4-1 / 4-1 / 4 tee is implanted into the 6 mm line, to which the line for VOCA perfusion and the line for BCS perfusion and cannula for bilateral cerebral perfusion are connected.

The system used in the prototype method allows more accurate control of the volumetric perfusion rate in the cerebral arteries, but does not provide for an isolated control of the perfusion rate and pressure in the arteries of each hemisphere of the brain.

In addition, there is no separate control and correction of the temperature of the patient's brain and body during the rewarming phase. When the distal anastomosis to the aorta is performed and the reconstruction of the vessels of the aortic arch begins, it is necessary to begin perfusion and gradual warming of the lower floor, while maintaining the temperature of the perfusion of the brain at 27-28 ° C.

In addition, there is no possibility of rewarming the patient after circulatory arrest with simultaneous selective perfusion of the brain under hypothermic conditions at the stage of performing anastomoses in the aortic arch.

The technical problem is to create a method and system for selective bilateral cerebral perfusion of the brain during reconstructive operations on the aortic arch, carried out under artificial circulation, allowing separate control of the perfusion rate and pressure in the arteries of each hemisphere of the brain, as well as to conduct prolonged hypothermia of the brain at the stage warming the patient.

The medical and technical result achieved with the implementation of the proposed group of inventions is to reduce neurological complications, reduce the incidence of multiple organ failure, provide the possibility of early activation of the patient, reduce hospital mortality when performing operations on the aortic arch and its branches, performed in conditions of hypothermia and circulatory arrest with pharmaco-cold cardioplegia due to prolonged hypothermia of the brain at the stage of warming the patient, control of the rate of perfusion and pressure in the arteries of each hemisphere of the brain.

The proposed group of inventions allows perfusion of the brain with a system of selective bilateral cerebral perfusion, combined with a physiological unit in such a way that it becomes possible to perform separate supply of oxygenated blood through the BCS and LOSA at a given volumetric rate and temperature under pressure control in each line.

The proposed system of selective bilateral cerebral perfusion provides the possibility of isolated control and correction of the volumetric perfusion rate and perfusion pressure in both hemispheres of the brain, as well as independent thermoregulation of the blood circulation circuits of the brain and the patient's body.

The essence of the invention is as follows.

The proposed system for selective bilateral cerebral perfusion during reconstructive surgery on the aortic arch, performed under artificial circulation, includes a series-connected cardiotomy reservoir, the first pump, an oxygenator, the outlet of which is connected to the port of the arterial line.

The system also contains a circulation tank, a heat exchanger, a VOC port, a BCS port, the second and third pumps, the first, second and third pressure sensors, and six branch tees. Moreover, the outlet of the oxygenator is connected in series with the port of the arterial line through the first tee-splitter and the first pressure sensor, one of the ports of the first tee-splitter is connected to the first port of the second tee-splitter, which serially connects the inputs of the circulation tank and the heat exchanger.

The inlet of the heat exchanger through the third tee is connected to the LOSA and BCS ports by individual lines, one of which contains the second pump and the second pressure sensor, and the other contains the third pump and the third pressure sensor, while the outlet of the circulation tank is connected through the fourth, fifth and sixth tees to the lines VOC and BCS.

Also proposed is a method for selective bilateral perfusion of the brain during reconstructive surgery on the aortic arch performed under artificial circulation, in which the above system is used. Connect the cardiotomy reservoir with the right atrium or superior vena cava and inferior vena cava. Circulatory arrest is performed after reaching hypothermia of 27-28 ° C by blocking the arterial line connected to the aorta and used during cardiopulmonary bypass. Antegrade perfusion of the brain through the LOSA and BCS is carried out by connecting the ports of the lines for perfusion of the LOSA and BCS with the corresponding arteries of the patient. Under conditions of circulatory arrest, the circulation tank is turned off. Perfusion of the brain is carried out at a temperature of 27-28 ° C with separate supply of oxygenated blood by LOSA and BCS, maintaining a pressure of 50-70 mm Hg and a cerebral perfusion rate of at least 250 ml / min separately along the lines of LOSA and BCS. The circulation reservoir is connected when the volume of the patient's blood entering the cardiotomy reservoir exceeds the volume of the cardiotomy reservoir, using the circulation reservoir as a reservoir for storing blood. After the completion of the circulatory arrest by opening the arterial line and warming the patient, the brain perfusion is continued at a temperature of 27-28 ° C, keeping the circulation reservoir shut off, maintaining the above perfusion rate and pressure separately along the VOCA and BCS lines.

The essence of the inventions is illustrated by the following figures.

FIG. 1 shows a system for selective bilateral cerebral perfusion during reconstructive surgery on the aortic arch, performed under cardiopulmonary bypass.

FIG. 2 shows a diagram of cerebral perfusion under conditions of circulatory arrest.

FIG. 3 shows a diagram of the perfusion of the brain during the perfusion of the lower floor of the patient's body in conditions of his warming.

The figures show the following symbols:

1 - cardiotomy reservoir;

2 - pump 1;

3 - oxygenator with an integrated arterial filter;

4 - the first branching tee (arterial line);

5 - the first pressure sensor (arterial line);

6 - arterial highway;

7 - circulation tank;

8 - the second tee-splitter (connecting the arterial line with the brain perfusion unit);

9 - heat exchanger with built-in temperature sensor;

10 - third tee-splitter (dividing lines for cerebral perfusion);

11 - pump 2;

12 - pump 3;

13 - second pressure sensor (LOSA line);

14 - third pressure sensor (BCS line);

15 - fourth tee-splitter (OLSA lines);

16 - fifth tee-splitter (BCS lines);

17 - line for VOCA perfusion;

18 - line for BCS perfusion;

19 - hemoconcentrator;

20 is the sixth branch tee.

The system for selective bilateral cerebral perfusion during reconstructive surgery on the aortic arch, performed under cardiopulmonary bypass, includes a series-connected cardiotomy reservoir 1, a first pump 2, an oxygenator 3. The output of an oxygenator 3 is connected through the first tee-splitter 4 and the first pressure sensor 5 with the port of the arterial line 6. The inlet of the circulation tank 7 is connected in series with the inlet of the heat exchanger 9 by means of the second tee-splitter 8. The first port of the first tee-splitter 4 is connected to the first port of the second tee-splitter 8. The outlet of the heat exchanger 9 is connected through the third tee 10 with VOCA and BCS ports with individual lines - line 17 for VOCA perfusion and line 18 for BCS. Line 17 for VOCA perfusion contains a second pump 11 and a second pressure sensor 13. Line 18 for BCS perfusion contains a third pump 12 and a third pressure sensor 14. The outlet of the circulation reservoir 7 is connected through the fourth tee-branch 15 and the sixth tee-branch 20 with the line for perfusion of LOSA 17, and through the fifth tee-branch 16 and the sixth tee-branch 20 with the line for perfusion BCS 18. Hemoconcentrator 19 is located between the cardiotomy reservoir 1 and an oxygenator 3 (Fig. 1).

The method is carried out as follows.

At the preoperative stage, in a sterile room, in compliance with the rules of asepsis and antiseptics, disposable systems of the physiological unit are assembled, which provides for artificial circulation and hemoconcentration, which includes a cardiotomy reservoir 1, the first pump 2, an oxygenator 3 with an integrated arterial filter, the first tee 4 (3 / 8-3 / 8-1 / 4) of the arterial line, the first pressure sensor 5 connected to the arterial line 6, as well as a hemoconcentrator 19.

The selective cerebral perfusion unit includes a circulation tank 7, a second tee 8 (1 / 4-1 / 4-1 / 4) with a luer port, a heat exchanger 9 with a built-in temperature sensor, a 6 mm line with a third tee 10 (1 / 4- 1 / 4-1 / 4) and then two silicone fragments, the second pump 11, the third pump 12, the VOCA perfusion pressure sensor 13, the BCS perfusion pressure sensor 14, the fourth tee 15 (1 / 4-1 / 4-1 / 4) OLSA line, fifth tee 16 (1 / 4-1 / 4-1 / 4) of the BCS line, line 17 for VOCA perfusion, line 18 for BCS perfusion.

The assembly of the cardiotomy reservoir 1 and the oxygenator 3 is performed using a set of sterile lines supplied with the physiological unit for cardiopulmonary bypass. The patient's venous blood enters the cardiotomy reservoir 1 and, with the help of the first pump 2, is pumped into the oxygenator 3. After the oxygenator 3, along the arterial line 6 that takes off from it, into which the first tee 4 and the first pressure sensor 5 of the arterial line are installed, represented by the adapter 3 / 8- 3/8 with luer-port and line for measuring pressure, oxygenated blood enters the aorta.

The procedure for collecting a heart-lung unit (physiological unit) is described, for example, in the Clinical Evaluation of the Terumo Capiox® FX05 Hollow Fiber Oxygenator with Integrated Arterial Line Filter. Joseph Deptula, MS, CCP, Melinda Valleley, MS, CCP, Kimberly Glogowski, MS, CCP, John Detwiler, BS, RRT, James Hammel, MD, and Kim Duncan, MD. J Extra Corpor Technol. 2009 Jul; 41 (4): 220-225.

The block for selective bilateral cerebral perfusion is a system of highways 6 mm in diameter with a circulating reservoir 7 connected in series, a second tee 8 with a luer port connecting the arterial line 6 with a circulating reservoir 7 and a heat exchanger 9 with a built-in temperature sensor. After the heat exchanger 9, the line is divided into two separate lines 17 and 18 by means of the third tee 10. A second pump 11 is installed in the line 17 for perfusion of the OLSA. The third pump 12 is installed in the line 18 of the BCS perfusion. After exiting the second pump 11, a second pressure sensor 13 of the OLSA line is installed into the line for perfusion of the OLSA 17, which is a 1 / 4-1 / 4 adapter with a luer port and a line for measuring pressure, after which the fourth tee 15 of the line for the OLSA is implanted. Further, the free port of the line 17 for VOCA perfusion is connected to a cannula for retrograde cardioplegia (coronary sinus) with an inflatable 15 Fr cuff located in the patient's VOCA (not shown in the figures). After leaving the third pump 12, the BCS line pressure sensor 14 is implanted into the BCS line 18, which is a 1 / 4-1 / 4 adapter with a luer port and a pressure measurement line, after which a tee 16 of the BCS line is installed. Next, the free port of the line 18 for perfusion of the BCS is connected to a cannula for retrograde cardioplegia (coronary sinus) with an inflatable cuff 15 Fr located in the BCS (not shown in the figures).

The fourth and fifth branch tees 15 and 16 are necessary for recirculation in the cerebral perfusion unit for adequate deaeration and maintaining the specified temperature of the perfusate by connecting highways 17 and 18 to the circulation tank 7.

After assembling the block for cardiopulmonary bypass and the block for selective bilateral cerebral perfusion, they are connected through tees-branching 4 and 8.

Auxiliary blood circulation during reconstructive surgery on the aortic arch, carried out in conditions of artificial circulation, includes the following stages:

1 - artificial circulation with pharmaco-cold cardiology;

2 - perfusion of the brain in conditions of circulatory arrest (in which there is no blood supply to the lower floor of the patient's body);

3 - perfusion of the brain during the perfusion of the lower floor of the patient's body in conditions of its warming.

The proposed system can be used at all three stages of the assisted circulation. At the first stage, a block for cardiopulmonary bypass can be used, and a block for cerebral perfusion can be used for pharmaco-cold cardiology. In this case, the ports of highways 17, 18 for perfusion of VOCA and BCS are connected to the coronary arteries and block the connection between the first 4 and the second 8 branching tees, the fourth 15, the fifth 16 and the sixth 20 branching tees, respectively, and the circulation tank 7 is filled with Custodiol solution. Pharmacofolas cardioplegia can be performed using other systems.

In the operating room, the physiological unit is filled with a solution of gelofusin 500 ml, mannitol 100 ml, sodium bicarbonate 100 ml with heparin 1 ml, Plasmalit 250 ml. The block for the perfusion of the brain is filled with Ringer's solution, while the line connecting the tees-branching 4 and 8 is pinched.

Artificial blood circulation is started, connecting the cardiotomy reservoir with the right atrium or superior vena cava and inferior vena cava of the patient, and the port of the arterial line with the aorta. Pharmaco-cold cardiology is performed.

Before perfusion of the brain, the line is clamped between the circulation reservoir 7 and the fourth tee-branching 15 and the fifth tee-branching 16, as well as between the circulation reservoir 7 and the tee-branching 8, thus disconnecting the circulation reservoir 7.

After reaching the target hypothermia of 27-28 ° C, a circulatory arrest is made by blocking the port of the arterial line 6 in front of the pressure sensor 5 of the arterial line, while opening the connection between the physiological block of the arterial line 6 and the cerebral perfusion unit between the branching tees 4 and 8. The junction blocks on the side of the selective cerebral perfusion block is the middle of the 6 mm line running from the circulation tank to the heat exchanger. The second tee-splitter 8 (Fig. 2) is installed at the mentioned point of connection of the blocks.

Perfusion of the brain under conditions of circulatory arrest is performed using cannulas for the coronary sinus with an inflatable cuff 15 Fr, implanted in the OLSA and BCS with preliminary displacement of Ringer's solution with a physiological block perfusate.

When the volume of blood in the cardiotomy reservoir 1 is exceeded, the circulation reservoir 7 is used as a reservoir for storing blood by opening the line between the circulation reservoir 7 and the second tee-branching 8 with its subsequent introduction into the body. If necessary, hemoconcentration is performed using hemoconcentrator 19. In the process of hemoconcentration, the liquid part of the blood is removed and the formed elements are left, returning them to the cardiotomy reservoir, thereby controlling the hematocrit.

The key point in the distribution of blood across the VOCA and BCS is to achieve the target pressure of 50-70 mm Hg in each of these vessels. Perfusion of the brain is carried out at a rate of cerebral perfusion of at least 250 ml / min separately along the VOCA and BCS highways.

The perfusion of the lower floor after opening the arterial line 6 with gradual warming of the patient and selective perfusion of the brain at a temperature of 27-28 ° C is carried out according to the scheme shown in FIG. 3. At the same time, parallel perfusion of the lower floor of the patient's body and perfusion of the brain are performed. Perfusion of the brain is carried out at a temperature of 27-28 ° C, with separate supply of oxygenated blood through the BCS and LOSA at a rate of at least 250 ml / min, a pressure of 50-70 mm Hg, maintaining these perfusion parameters separately through the LOSA and BCS lines.

After the end of the surgical procedures on the vessels, the perfusion of the brain stops. Once effective cardiac activity has been restored and the patient has been warmed to the target 37 ° C, cardiopulmonary bypass is stopped. We provide evidence of the possibility of realizing the stated purpose and achieving the indicated medical and technical result.

Clinical example.

Patient G. 31 years old with a diagnosis of Marfan's syndrome. De Bakey type I dissecting aortic aneurysm, subacute stage. Insufficiency of the aortic valve 3rd stage. Relative insufficiency of the mitral and tricuspid valves. Pulmonary hypertension 3 degrees. NK 2B. FC (functional class) 3. Height 185 cm, weight 70 kg. Body surface area 1.92 m ² . Surgery protocol: Median sternotomy. The pericardium was opened, taken on holders, in its cavity there were about 200 ml of transparent liquid. The heart is enlarged due to the left ventricle, systolic-diastolic tremor over the aorta, the pulmonary artery is not tense. The aorta in the ascending section is expanded to 8 cm. The aneurysmal expansion of the aorta ends at the junction of the ascending section in the aortic arch. Further, the aorta is about 2 cm in diameter. The aortic arch and vena cava were cannulated, bypassing the latter. Cardiopulmonary bypass (CI) with hypothermia of 27 ° C was started, after clamping of the aorta, the myocardium was protected with cooled cardioplegic solution "Custodiol" (3 liters) into the orifices of the coronary arteries, and the heart was drained through the right superior pulmonary vein.

Longitudinal aorthotomy was performed after cardioplegia. On examination, the wall of the aorta is degeneratively changed, thinned. The dissection begins in the area of the Valsalva sinuses of the non-coronary and right coronary artery with the separation of the mouth of the right coronary artery and goes beyond the aortic forceps. The aortic wall is dissected circularly with multiple intimal tears in the ascending section. The aortic valve is tricuspid, the cusps with the marginal seal sag into the left ventricular cavity together with the detached commissures, the fibrous ring of the aortic valve is about 3 cm. It was decided to replace the ascending aorta using David's technique. The ascending aorta was excised with the isolation of the commissures of the aortic valve and the orifices of the coronary arteries at the sites. The fibrous ring of the aortic valve was stitched with 12 U-shaped sutures on the gaskets from the side of the ventricle with an injection outward. The aortic root was reimplanted into the Gelweave-32Valsalva vascular prosthesis. The aortic valve commissures are fixed to the prosthesis from the side of its lumen with a continuous twisted suture prolene 5-0. Plication of the right coronary and non-coronary leaflets was performed with several interrupted sutures. Anastomoses of the orifices of the left and right coronary arteries with an end-to-side prosthesis were made with a continuous twisted suture prolen 5-0. Against the background of hypothermia at 27 ° C, extracorporeal circulation (circular arrest) was stopped and bilateral selective cerebral perfusion through the VOCA and BCS was started. Perfusion rate according to LSA 250 ml / min and BCS 300 ml / min at a temperature of 27 ° C. The pressure in this case is 50 mmHg and 70 mmHg in VOCA and BCS, respectively. The clamp was removed from the aorta. The wall of the aorta at the level of the arch is also delaminated into 2/3 with intimal ruptures in several places and separation of the orifices of the BCS and LOSA. The aortic arch is excised. A continuous twisted suture formed a distal anastomosis of a multi-branch prosthesis with a descending aorta with a "sandwich" -type plastic aortic wall. Cannulation of the additional branch of the prosthesis. Perfusion of the distal regions was started with gradual warming of the patient's body, selective cerebral perfusion was continued at a temperature of 28 ° C, a pressure of 50 mmHg and 70 mmHg in LOSA and BCS, respectively, the perfusion rate by LOSA was 250 ml / min and BCS was 290 ml / min. An anastomosis of the distal branch of the prosthesis with the left subclavian artery was formed with a continuous twisted suture prolene 5-0. The blood flow is started through the subclavian artery. An interprosthetic anastomosis (prosthesis of the ascending aorta and multi-branch prosthesis) was formed with a continuous twisted suture prolene 5-0. The clamp was removed from the aorta, the coronary blood flow was restored. An anastomosis of the middle branch of the prosthesis with the spruce carotid artery was formed with a continuous twisted suture prolene 5-0. The blood flow was started on the VOCA. An anastomosis of the proximal branch of the prosthesis with the BCS was formed with a continuous twisted suture of prolene 5-0. The blood flow through the BCS was started. After rewarming the patient, cardiac activity was restored with the help of two defibrillator discharges, almost immediately with sinus rhythm. At the end of the operation, satisfactory hemodynamics against the background of moderate doses of catecholamines (Dopamine 3 μg / kg / min and Dobutamine 2 μg / kg / min). Completed artificial blood circulation, decannulation of the vena cava and aorta. The perfusion branch is tied with suturing. An electrode is sutured to the myocardium of the right ventricle. Hemostasis. The cavity of the pericardium and the anterior mediastinum are drained, the pericardium is sutured, the sternum is tightened with 5 wire sutures. The postoperative wound was sutured tightly in layers. Antiseptic treatment. Aseptic sticker. Cardiopulmonary bypass time - 271 min, myocardial ischemia - 216 min, circulatory arrest - 40 min, selective cerebral perfusion - 110 min. Ultrafiltration was performed with a volume of 4600 ml. During all stages of the operation, the blood pressure in the left and right radial and right femoral arteries was monitored, the volumetric rate of perfusion through the vessels of the brain under pressure and the "cooling-warming" temperature were monitored. The dynamics of laboratory data is presented in table 1. The time spent in the intensive care unit was 39 hours, the early postoperative period on the 4th day after the operation was complicated by hydrothorax - puncture of the right pleural cavity was performed. The patient was discharged in satisfactory condition, in the hospital for 19 bed-days.

The result obtained using the proposed method is to improve and simplify the quality of all stages of artificial and assisted circulation in this pathology. The use of the method leads to an increase in the number of reconstructive operations on the aortic arch, satisfactory neuroprotection, a decrease in the length of stay of patients in the intensive care unit and a decrease in hospital bed-days.

Claims (6)

1. A system for selective bilateral cerebral perfusion during reconstructive surgery on the aortic arch, carried out under cardiopulmonary bypass, including a serially connected cardiotomy reservoir, the first pump, an oxygenator, the output of which is connected to the port of the arterial line, the port of the left common carotid artery (LOSA ), port of the brachiocephalic trunk (BCS), the second pump, characterized in that additionally includes a circulation tank, a heat exchanger, a third pump, the first, second and third pressure sensors, six branch tees, moreover: the oxygenator outlet is connected in series with the arterial line port through the first tee-splitter and the first pressure sensor, one of the ports of the first tee-splitter is connected to the first port of the second tee-splitter, which serially connects the inputs of the circulation tank and the heat exchanger; the outlet of the heat exchanger through the third tee is connected to the LOSA and BCS ports by individual lines, one of which contains the second pump and the second pressure sensor, and the other - the third pump and the third pressure sensor, while the outlet of the circulation tank is connected through the fourth, fifth and sixth tees to the lines VOC and BCS. 2. A method for selective bilateral cerebral perfusion during reconstructive surgery on the aortic arch, performed under cardiopulmonary bypass, including connecting the cardiotomy reservoir with the right atrium or superior vena cava and inferior vena cava, circulatory arrest after reaching hypothermia of 27-28 ° C by blocking the arterial line connected to the aorta and used for cardiopulmonary bypass, and antegrade perfusion of the brain through LOSA and BCS, characterized in that the system according to claim 1 is used for cerebral perfusion, connecting the ports of the main lines for perfusion of LOSA and BCS with the corresponding arteries of the patient, in under conditions of circulatory arrest, the circulation reservoir is turned off and the brain is perfused at a temperature of 27-28 ° C with a separate supply of oxygenated blood by LOSA and BCS, maintaining a pressure of 50-70 mm Hg and a cerebral perfusion rate of at least 250 ml / min separately through the highways VOC and BCS; the circulation reservoir is connected when the volume of the patient's blood entering the cardiotomy reservoir exceeds the volume of the cardiotomy reservoir, using the circulation reservoir as a reservoir for storing blood; after the completion of the circulatory arrest by opening the arterial line and warming the patient, the cerebral perfusion is continued at a temperature of 27-28 ° C, keeping the circulation reservoir shut off, maintaining the above perfusion rate and pressure separately along the LOSA and BCS lines.

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