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Best strategy for cerebral protection in arch surgery - antegrade selective cerebral perfusion and adequate
Martin Misfeld1, Friedrich W Mohr, Christian D Etz
1Department of Cardiac Surgery, Leipzig Heart Center - University of Leipzig, Leipzig, Germany.
Aortic arch surgery remains a complex surgical operation that necessitates specific neuroprotection strategies. Various approaches, such as hypothermic circulatory arrest (HCA), retrograde cerebral perfusion, and antegrade selective cerebral perfusion (aSCP), have each enjoyed periods of popularity. However, while the overall surgical approach tend to favour HCA with aSCP, technical factors, such as perfusion site, perfusate temperature and flow rate and pH management, have not been conclusively elucidated. The optimal extent of hypothermia during circulatory arrest is also unclear, particularly with recent partiality for warmer temperatures. The following perspective details the preferred surgical practice for cerebral protection in aortic arch surgery, based on existing evidence.
Aortic arch surgery remains a complex surgical operation that necessitates specific neuroprotection strategies. Various approaches, such as hypothermic circulatory arrest (HCA), retrograde cerebral perfusion, and antegrade selective cerebral perfusion (aSCP), have each enjoyed periods of popularity. However, while the overall surgical approach tend to favour HCA with aSCP, technical factors, such as perfusion site, perfusate temperature and flow rate and pH management, have not been conclusively elucidated. The optimal extent of hypothermia during circulatory arrest is also unclear, particularly with recent partiality for warmer temperatures. The following perspective details the preferred surgical practice for cerebral protection in aortic arch surgery, based on existing evidence.
