Retrograde cerebral perfusion to support aortic arch repair

Acute type A aortic dissection (ATAAD) and aortic arch aneurysms are life-threatening conditions requiring complex surgical intervention, often involving circulatory arrest. Cerebral ischemia and neurological complications remain significant challenges in aortic arch surgery. This narrative review focuses on retrograde cerebral perfusion (RCP) techniques used to mitigate these risks. This review article examines the evolution of cerebral protection strategies, with a focus on the techniques, parameters, and monitoring of RCP. It also compares RCP with antegrade cerebral perfusion (ACP) and deep hypothermic circulatory arrest (DHCA) regarding clinical outcomes. RCP has proven to be a valuable adjunct to DHCA in aortic arch surgery, offering comparable outcomes to ACP and demonstrating superiority over DHCA alone. Precise management of venous pressure and flow rate during RCP, along with meticulous cerebral monitoring, is crucial for optimizing neurological protection. Although ACP is increasingly favored in clinical practice, RCP continues to be a safe and effective cerebral protection strategy.