Key result
Selective antegrade cerebral perfusion is increasingly preferred over retrograde cerebral perfusion during complex open aortic arch surgery to provide extended safe time limits for cerebral ischemia.
Why the study?
Neuroprotection is critical during open aortic arch surgery due to the dependence of brain tissues on cerebral perfusion, prompting the development of multiple techniques to reduce cerebral ischemia.
SACP combined with moderate hypothermia is emerging as the preferred neuroprotective strategy for complex open aortic arch surgery, balancing adequate cerebral and spinal cord protection with reduced hypothermia-related complications.
May guide perfusion strategy selection in arch repair; leaves open need for RCTs to confirm outcomes.
Neuroprotection is important in open aortic arch surgery because of the dependence of brain tissues on cerebral perfusion. Therefore, several techniques have been developed to reduce cerebral ischemia and improve outcomes in open aortic arch surgery. In this review, I describe various neuroprotective strategies, such as profound and deep hypothermic circulatory arrest, selective antegrade cerebral perfusion, retrograde cerebral perfusion, and lower body circulatory arrest; compare their advantages and disadvantages, and discuss their evolution and current status by reviewing relevant literature.
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Ryuzo Bessho (2022) conducted a review in Open aortic arch surgery. Cerebral perfusion methods and temperature management was evaluated. Selective antegrade cerebral perfusion is increasingly preferred over retrograde cerebral perfusion during complex open aortic arch surgery to provide extended safe time limits for cerebral ischemia.
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