Cerebral protection for aortic arch surgery: mild hypothermia with selective cerebral perfusion

Historically, reconstruction of the aortic arch has been exclusively performed during deep hypothermic circulatory arrest. Antegrade cerebral perfusion (ACP) has been popularized, offering a more physiologic method of perfusion and extending the safe limits for arch repair. Initially, deep hypothermia has been used as an adjunct to ACP almost universally. More recently, the absolute necessity for deep hypothermia during aortic surgery once ACP with flow rates and pressures within the physiologic range is provided has been questioned from our institution, as well as others. To our best knowledge we have been one of the pioneering centers to start such an aggressive temperature management in aortic arch surgery back in 2000. To date 426 patients underwent aortic arch replacement in our unit employing the standardized surgical protocol described herein.