Key result
Aortic surgery neuroprotection strategies show variable efficacy and require further research.
Why the study?
Neurological injury poses a significant challenge in aortic surgery, and a fully effective strategy for preventing or treating it remains elusive.
What are the most common neuroprotective strategies implemented for aortic arch and aortic surgery to prevent neurological injury?
What are the most common neuroprotective strategies implemented for aortic arch and aortic surgery to prevent neurological injury?
This narrative review highlights the variety of neuroprotective strategies available for aortic surgeries, emphasizing that while many techniques exist, their efficacy varies and further research is needed to refine prevention of brain injury.
Answers are grounded in this paper and cite their sources.
Clinicians should individualize neuroprotection choices in aortic surgery; this leaves open the comparative effectiveness of strategies for future trials.
Background: Neurological injury poses a significant challenge in aortic surgery, encompassing spinal cord injury from thoraco-abdominal aorta intervention or stroke post-surgery on the arch and ascending aorta. Despite ample literature and proposals, a fully effective strategy for preventing or treating neurological injury remains elusive. This narrative review aims to analyze the most common neuroprotective strategies implemented for aortic arch surgery and aortic surgery. Results: Results from the reviewed studies showed that several strategies, including deep hypothermia cardiac induction (DHCA) and cerebral perfusion techniques (retrograde cerebral perfusion, RCP, and selective anterograde cerebral perfusion, SACP) aim to mitigate these risks. Monitoring methods such as electroencephalogram (EEG), somatosensory evoked potential (SEPs), and near-infrared spectroscopy (NIRS) offer valuable insights into cerebral function during surgery, aiding in the management of hypothermia and perfusion. Pharmacological agents and blood gas management (pH stat vs. alpha stat, hematocrit level, glycemic control) are crucial in preventing post-operative complications. Additionally meticulous management of atheromatous debris is essential to minimize embolic risks during surgery. Methods: For this narrative review, PubMed, Scopus, and Medline have been used to search articles about neuroprotection strategies in aortic and aortic arch surgeries. The search was narrowed to articles between 1975 and 2024. A total of 3418 articles were initially identified to be potentially relevant for this review. A total of 66 articles were included and were found to match the inclusion criteria. Conclusions: While an overabundance of neuroprotection strategies exists for cardiac surgery, particularly in procedures involving the aorta and the arch, their efficacy varies, with some well-documented and others still under scrutiny. Further research is imperative to advance our comprehension and refine prevention techniques for cardiac-surgery-related brain injury. This is crucial given its substantial contribution to both mortality and, notably, post-operative morbidity.
No takes yet. Share an insight, caveat, or question.
Torre et al. (2024) conducted a review in Neurological injury in aortic surgery (n=66). Neuroprotective strategies was evaluated on Efficacy of neuroprotective strategies in preventing or treating neurological injury. A narrative review of 66 articles found that while numerous neuroprotection strategies exist for aortic surgery, their efficacy varies, highlighting the need for further research.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: