Retrograde cerebral perfusion to support aortic arch repair

Area of Science:

• Cardiovascular Surgery
• Neurological Protection Strategies
• Aortic Arch Surgery

Background:

• Acute type A aortic dissection (ATAAD) and aortic arch aneurysms necessitate complex surgical interventions, frequently involving circulatory arrest.
• Cerebral ischemia and neurological complications are significant risks associated with aortic arch surgery.

Purpose of the Study:

• To review the evolution of cerebral protection strategies in aortic arch surgery.
• To focus on retrograde cerebral perfusion (RCP) techniques, including their parameters and monitoring.
• To compare RCP with antegrade cerebral perfusion (ACP) and deep hypothermic circulatory arrest (DHCA) regarding clinical outcomes.

Main Methods:

• Narrative review of existing literature on cerebral protection during aortic arch surgery.
• Examination of techniques, parameters, and monitoring protocols for RCP.
• Comparative analysis of clinical outcomes between RCP, ACP, and DHCA.

Main Results:

• Retrograde cerebral perfusion (RCP) is a valuable adjunct to deep hypothermic circulatory arrest (DHCA) in aortic arch surgery.
• RCP demonstrates comparable clinical outcomes to antegrade cerebral perfusion (ACP) and superior outcomes to DHCA alone.
• Precise management of venous pressure and flow rate during RCP, alongside meticulous cerebral monitoring, is crucial for neurological protection.

Conclusions:

• Retrograde cerebral perfusion (RCP) is a safe and effective cerebral protection strategy in aortic arch surgery.
• While antegrade cerebral perfusion (ACP) is increasingly favored, RCP remains a viable and effective option.
• Optimizing neurological protection during aortic arch surgery requires careful attention to RCP parameters and monitoring.