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Cerebral protection during surgery for aortic arch aneurysms
1Department of Thoracic and Cardiovascular Surgery, Kansai Medical University, 10-15 Fumizono-cho, Moriguchi, Osaka 570-8507, Japan.
Summary
Deep hypothermic circulatory arrest (DHCA) with selective cerebral perfusion (SCP) is preferred for aortic arch surgery to protect the brain. While effective, prolonged DHCA and cardiopulmonary bypass (CPB) require further research to mitigate risks.
Area of Science:
- Cardiovascular Surgery
- Neurosurgery
- Medical Technology
Background:
- Aortic arch surgery poses significant risks of cerebral complications.
- Current neuroprotective strategies include deep hypothermic circulatory arrest (DHCA), moderate hypothermic circulatory arrest, DHCA with selective cerebral perfusion (SCP), and DHCA with retrograde cerebral perfusion (RCP).
Purpose of the Study:
- To evaluate the efficacy and limitations of various cerebral protection methods during transverse and distal aortic arch repair.
Main Methods:
- Review of current techniques for cerebral protection during aortic arch surgery.
- Discussion of the advantages and disadvantages of DHCA, RCP, and SCP.
Main Results:
- DHCA alone has limited safe duration.
- RCP can extend safe DHCA time.
- SCP allows for extended cerebral isolation and protection.
- DHCA with SCP is the preferred method due to advancements in cardiopulmonary bypass (CPB) materials and myocardial preservation.
Conclusions:
- DHCA with SCP is a preferred adjunct for cerebral protection in aortic arch surgery.
- Further research is needed to address potential increases in mortality and morbidity associated with prolonged DHCA and CPB.