[Surgical replacement of the aortic arch]

Area of Science:

• Cardiovascular Surgery
• Neurological Protection
• Hypothermia Techniques

Context:

• Aortic arch replacement surgery necessitates effective cerebral protection.
• Traditional deep hypothermia limits surgical time and prolongs cardiopulmonary bypass, increasing complication risks.
• Selective carotid artery perfusion presents challenges in maintaining adequate cerebral perfusion.

Purpose:

• To describe and evaluate a new technique for cerebral protection during aortic arch surgery.
• To reconcile the benefits of deep hypothermia and selective perfusion while mitigating their drawbacks.
• To assess the efficacy and safety of selective antegrade brain perfusion with cooled blood.

Summary:

• A technique involving selective carotid artery perfusion with blood cooled to 6-12°C, while maintaining moderate systemic hypothermia (25-28°C), was developed.
• This method allows for an "open" distal anastomosis by temporarily stopping cardiopulmonary bypass while maintaining cerebral perfusion.
• Over 158 patients, this technique demonstrated effective cerebral protection, with rapid return of EEG activity and acceptable neurological complication rates.

Impact:

• The technique provides adequate cerebral protection without necessitating prolonged cardiopulmonary bypass or limiting aortic repair time.
• It offers a valuable alternative for cerebral protection in aortic arch surgery, potentially reducing associated morbidity.
• This approach may become the preferred method for safeguarding the brain during complex aortic arch procedures.