[Brain Protection for Shaggy Aorta During Aortic Arch Surgery]

Although short and long-term outcomes of aortic surgeries have been improving over the past decade, the procedure is likely to be asscociated with life-threatening complications such as neurological deficits caused by suboptimal brain protection or heavily diseased aorta. Contemporary strategies for brain protection are deep hypothermic arrest with or without retrograde cerebral perfusion retrograde cerebral perfusion or selective antegrade cerebral perfusion. At the moment, majority of evidences failed to show the superiority of selective antegrade cerebral perfusion to retrograde one. Shaggy aorta( atherothrombotic aorta) was defined as very extensive atheromatous disease with diffuse ulcers associated with soft, loosely held debris and a paucity of actual thrombus and is the prototypical potential embolic source for neurological deficits. Non-physiological flow during cardiopulmonary bypass causes the detachment of atheroma and consequently the debris was washed away into the carotid arteries. Therefore, meticulous selection of cannulation site and type of cannula (a dispersion cannula) and complete exclusion of the diseased aorta contributed to avoiding permanent neurological deficits even when atherothrombotic aorta was present. Shaggy aorta combined with leukoaraiosis, extracranial carotid artery stenosis, and prolonged cardiopulmonary bypass time exponentially increased postoperative transient neurological deficits in patients undergoing total aortic arch replacement, and may therefore deserve special attention.