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Unilateral cerebral perfusion effectively protects the brain during aortic arch surgery. Both left- and right-sided approaches showed similar outcomes, with no significant differences in neurovascular monitoring or clinical results.

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Area of Science:

  • Cardiovascular Surgery
  • Neurosurgery
  • Cerebral Perfusion Techniques

Background:

  • Unilateral cerebral perfusion (UCP) is increasingly used for brain protection during aortic arch surgery.
  • Optimal surgical strategies, including perfusion pressure, flow, and temperature, require further clarification.
  • Understanding collateral flow pathways is crucial for effective brain protection.

Purpose of the Study:

  • To evaluate differences between left- and right-sided UCP during aortic arch surgery.
  • To compare neurovascular monitoring findings between the two UCP approaches.
  • To assess the clinical outcomes associated with left- vs. right-sided UCP.

Main Methods:

  • A retrospective study of 200 patients undergoing elective aortic arch surgery (2005-2008).
  • 100 patients received left-sided UCP via the left common carotid artery.
  • 100 patients received right-sided UCP via the right carotid and vertebral arteries.

Main Results:

  • Mild hypothermic circulatory arrest (30.1-31.6°C) was used in both groups.
  • Circulatory arrest duration was similar (17.2 min) for both left- and right-sided UCP.
  • No significant differences in contralateral middle cerebral artery flow velocities were observed; 30-day mortality was 0%, with two minor strokes.

Conclusions:

  • Unilateral cerebral perfusion under mild hypothermia is an effective brain protection strategy.
  • No significant advantage of right-sided UCP (perfusing two arteries) over left-sided UCP was demonstrated.
  • Further research may refine UCP strategies for aortic arch repair.