[Brain protection during operation for aortic arch aneurysms].

Area of Science:

• Cardiovascular Surgery
• Neurological Protection
• Vascular Imaging

Context:

• Aortic arch replacement is a complex procedure requiring meticulous surgical technique.
• Moderate hypothermic circulatory arrest and antegrade selective cerebral perfusion are standard methods.
• Preventing permanent neurological deficit is a primary concern in aortic arch surgery.

Purpose:

• To evaluate the safety and efficacy of moderate hypothermic circulatory arrest with antegrade selective cerebral perfusion for aortic arch replacement.
• To identify key factors for preventing neurological complications during the procedure.
• To assess the outcomes of aortic arch replacement in a large patient cohort.

Summary:

• A comprehensive pre-operative evaluation including computed tomography (CT), magnetic resonance imaging (MRI), and intraoperative epiaortic echography is crucial for safe cannulation and cerebral perfusion.
• Surgical techniques emphasizing good exposure, irrigation, and flushing of atheromatous debris are vital.
• In a series of 410 aortic arch replacements (1991-2013), overall mortality was 5.4% and stroke rate was 2.4%, with higher rates in emergency cases.
• Antegrade selective cerebral perfusion facilitates secure distal anastomosis but atheroembolism from a "shaggy" aorta persists as an unresolved issue.

Impact:

• This study highlights the importance of advanced imaging and meticulous surgical technique in reducing neurological complications during aortic arch replacement.
• The findings underscore the effectiveness of antegrade selective cerebral perfusion in protecting the brain and enabling complex aortic reconstructions.
• Further research is needed to address the challenge of atheroembolism in patients with atherosclerotic aortas undergoing arch surgery.