Cerebral and Spinal Cord Protection Strategies in Aortic Arch Surgery.

Area of Science:

• Cardiovascular Surgery
• Neurosurgery
• Anesthesiology

Background:

• Aortic arch surgery presents significant challenges due to high risks of neurological complications.
• Patient outcomes are affected by both the underlying disease and surgical interventions.
• Maintaining adequate blood flow and oxygen supply to the brain and spinal cord is critical.

Purpose of the Study:

• To review current neuroprotection and spinal cord protection strategies for aortic arch surgery and stenting.
• To highlight the importance of maintaining cerebral and spinal cord perfusion.
• To discuss methods for reducing metabolic oxygen demand during these procedures.

Main Methods:

• Review of established and emerging neuroprotective and spinal cord protective techniques.
• Discussion of moderate hypothermia as a neuroprotective measure.
• Emphasis on selective antegrade perfusion techniques for maintaining organ perfusion.

Main Results:

• Moderate hypothermia and selective antegrade perfusion are identified as promising methods.
• These techniques aim to balance the competing perfusion needs of the brain and spinal cord.
• Intraoperative and postoperative monitoring is crucial for early detection of neurological injury.

Conclusions:

• Effective perioperative management is essential for reducing neurological deficits in aortic arch surgery.
• Combining hypothermia and selective perfusion offers a robust approach to neuroprotection.
• Continuous monitoring facilitates timely intervention against spinal cord ischemia and stroke.