Preoperative selection of cerebral perfusion strategies is imperative to maintain maximal diffuse cerebral protection and prevent focal neurologic events during aortic arch operations.
High neurologic risks in aortic arch surgery require careful perfusion planning; leaves open optimal strategy selection for prospective trials.
Neurologic injuries following aortic arch operations can be devastating, with stroke occurring in up to 12% of elective operations and significant cerebral dysfunction occurring in up to 25% of cases. The primary challenge unique to aortic arch operations involves interruption of direct perfusion of the brachiocephalic vessels during arch reconstruction. For this reason, neuroprotection is paramount. The 2 main modes of protection are (1) reducing metabolic demand through hypothermia and (2) limiting, or even eliminating, the ischemic period. Preoperative selection of the cerebral perfusion plan for each operation is imperative to maintain maximal diffuse cerebral protection and prevent focal neurologic events.
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Foley et al. (2016) studied this question.
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