Cerebral Perfusion and Protection During Repair of Type A Dissection

Patients with the highest risk of neurologic injury after cardiac surgery are those undergoing repair of type A aortic dissections. Since the 1950s, extensive research has been conducted to improve the safety and neurologic outcomes of these patients. Surgeons now routinely use hypothermia with circulatory arrest, and adjunctive cerebral perfusion methods. This article highlights the historic development of modern cerebral perfusion and protection, and discusses technical details and clinical outcomes of cannulation strategies, temperature management, and antegrade cerebral perfusion and retrograde cerebral perfusion.