A Clinical Protocol for Goal Directed Cerebral Perfusion during Aortic Arch Surgery

Area of Science:

• Cardiovascular Surgery
• Cerebral Protection Strategies
• Hypothermic Circulatory Arrest

Background:

• Optimal antegrade cerebral perfusion (ACP) for cerebral protection during hypothermic circulatory arrest (HCA) remains undefined.
• Existing ACP techniques often involve smaller cannulae, multiple cannulation sites, and lower cooling temperatures, potentially limiting efficacy.

Purpose of the Study:

• To present a current clinical protocol for selective ACP during aortic arch surgery.
• To compare this protocol with previously published experiences and techniques.

Main Methods:

• Implementation of selective ACP via the innominate artery since 2013.
• Utilization of moderate hypothermia and ancillary strategies like goal-directed perfusion (GDP).
• Comparison with published data on alternative ACP methods.

Main Results:

• The described protocol facilitates higher ACP flow rates.
• It avoids complications associated with additional cannulae required by other methods.
• The setup for dual arterial perfusion is simplified.

Conclusions:

• The presented clinical protocol may enhance cerebral protection during aortic arch surgery.
• Goal-directed perfusion (GDP) advances understanding of metabolic physiology for improved cerebral protection.
• This strategy offers potential advantages in flow, complication avoidance, and procedural simplicity.