Neuroprotection in aortic surgery

Operations on the aortic arch still remain a great challenge for cardiac surgeons and necessitate a period of cerebral blood flow interruption. lt is therefore imperative to protect the brain during this very sensitive time. Clinical as well as experimental studies have shown that the exact mechanism of neural injury seems to be multifactorial. Furthermore it is still uncertain, whether cerebral injury occurs during the interval of HCA or during reperfusion. Various strategies have been adopted in an effort to reduce neurological complications after aortic surgery. These included the use of hypothermic circulatory arrest, antegrade cerebral perfusion and retrograde cerebral perfusion. All these methods have both advantages and disadvantages. New surgical techniques such as cold reperfusion have shown promising results in animal experiments and need further clinical evaluation. One very promising pathway in preventing cerebral injury lies in pharmacological interventions.