[Problems of brain protection in aortic arch operations]

33 patients (25 men and 8 women, aged 18 to 69 years, mean age 47 +/- 12.3 years), underwent ascending aorta and aortic arch replacement. During arch replacement the authors used the following brain protection methods: profound hypothermic circulatory arrest--in 4 (12.1%) patients, retrograde brain perfusion via superior vena cava--in 11 (33.3%), antegrade perfusion via brachycephalic vessels--in 18 (54.6%) patients. Pharmacological brain protection was applied in all cases as an addition to the listed techniques. 14 (45%) patients underwent partial aortic arch replacement; in 19 (57.6%) patients total aortic arch replacement was performed, including "elephant trunk" distal anastomosis in 4 cases. Hospital mortality rate in patients who underwent operations on the aortic arch was 18.1% (6 patients). Postoperative neurological disorders, such as transient dysfunction, were observed in 8 (24%) patients; cerebral strokes or intractable neurological disorders were not recorded. The choice of a brain protection method is determined by the extent of the operation and necessary circulation arrest time.