Brain protection in open arch surgery

This review outlines the history of aortic arch surgery and examines classifications of hypothermia and mechanisms of perioperative neurological injuries. Risk factors for these neurological insults are explored, as well as cerebral monitoring systems available to mitigate such injuries. Furthermore, a comparative literature analysis evaluates outcomes among deep hypothermic circulatory arrest, retrograde cerebral perfusion, and antegrade cerebral perfusion. Finally, technical considerations for cerebral perfusion delivery and contemporary trends in temperature management are discussed.