Arch reconstruction without circulatory arrest: historical perspectives and initial clinical results

For many years, deep hypothermic circulatory arrest had been a necessary and unavoidable adjunct to surgical procedures including aortic arch reconstruction in neonates and infants. Despite meticulous investigation of bypass techniques for deep hypothermic circulatory arrest, unfavorable long-term neurologic deficits have been well documented. Currently, several cerebral perfusion techniques are used in neonatal arch reconstruction to avoid circulatory arrest and prevent brain ischemia. The techniques and their initial clinical results are presented and related problems discussed. Currently available circulatory arrest techniques should be avoided in favor of well-established continuous perfusion techniques, even for arch reconstruction.