Cerebral protection in hemi-aortic arch surgery.

Surgical therapy for aortic arch disease usually requires a period of hypothermic circulatory arrest, which calls for cerebral protection strategies and adjuncts. The optimal strategy for protecting the brain from irreversible ischaemic damage during the period of circulatory arrest remains controversial. Patients present with diverse aortic pathologies and this may dictate different cerebral protection methods that are tailored for the circumstances of each individual case. The purpose of this overview is to describe each method of cerebral protection employed in hemi-aortic arch surgery and to explain their advantages and disadvantages. A surgical case on hemi-aortic arch replacement using retrograde cerebral perfusion is demonstrated (Video 1). We also present our hospital demographics and outcomes pertaining to cerebral protection in hemi-aortic arch surgery. Video 1 Cerebral protection in hemi-aortic arch surgery The current practices employed for brain protection during aortic arch surgery include: (I) deep hypothermic circulatory arrest (DHCA); (II) retrograde cerebral perfusion (RCP); and (III) selective antegrade cerebral perfusion (SACP).