[Cerebral protection in aortic arch surgery]

In recent decades, the outcome of patients after thoracic aortic surgery has improved considerably. However, surgery of the thoracic aorta and, in particular, of the aortic arch is still associated with significant high mortality and morbidity caused by neurological complications resulting from temporary suspension of cerebral circulation. Cerebrovascular injuries in thoracic aortic surgery can be caused by inadequate cerebral protection, cerebral embolism and, in case of acute type A aortic dissection, cerebral malperfusion. The neurological outcome of these patients depends on the quality of central nervous system protection during the critical period of interruption of cerebral circulation. Various techniques have been proposed as a means of protecting the brain from ischemic injury, such as deep hypothermic circulatory arrest, retrograde cerebral perfusion, and antegrade selective cerebral perfusion. This review analyzes these three methods and the strategies of cerebral protection focusing on the advantages and disadvantages of each one.