Key result
MHCA with antegrade cerebral perfusion matches or exceeds DHCA for brain protection during arch surgery.
Why the study?
Open aortic arch surgery carries frequent neurologic complications and high mortality, while definitions for neurologic complications were set three decades ago.
The review suggests that moderate hypothermic circulatory arrest with antegrade cerebral perfusion offers comparable or better neuroprotection than deep hypothermic circulatory arrest, and proposes adopting the VARC neurologic dysfunction definitions for aortic arch surgery.
May support moderate hypothermia with ACP in arch surgery; leaves open need for randomized confirmation.
Open aortic arch surgery incurs frequent neurologic complications and high mortality. The disease processes of aortic aneurysm and acute aortic dissection, and the physiological trespass of cardiopulmonary bypass and hypothermic circulatory arrest (CA), can engender neurologic dysfunction such as postoperative stroke and delirium. While deep hypothermic CA (with and without retrograde cerebral perfusion) is the major strategy for brain protection, moderate hypothermic CA with antegrade cerebral perfusion has comparable or better outcomes. Classes of neurologic complications in aortic arch surgery were defined three decades ago. In 2021, the Valve Academic Research Consortium recommended new endpoints for assessing neurologic outcomes of transcatheter and surgical aortic valve procedures. Those parameters include neuroimaging biomarkers. Overt central nervous system (CNS) injury is the severe form and delirium is the common clinical presentation. Covert CNS injury, evidenced on brain imaging, is prevalent in patients following transcatheter aortic valve replacement (TAVR). The new definition for neurologic dysfunction after TAVR could serve in the classification of neurologic dysfunction in aortic arch surgery.
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Jason Zhensheng Qu (2023) conducted a review in Aortic arch surgery and neurologic dysfunction. Moderate hypothermic circulatory arrest with antegrade cerebral perfusion vs. Deep hypothermic circulatory arrest was evaluated. Moderate hypothermic circulatory arrest with antegrade cerebral perfusion provides comparable or better brain protection than deep hypothermic circulatory arrest during aortic arch surgery.
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