What are the surgical approaches, technical considerations, and clinical outcomes of cerebral perfusion strategies in minimally invasive hemiarch and ascending aortic surgery?
Optimal cerebral perfusion strategies are critical to mitigating the high risks of mortality and neurological injury during minimally invasive hemiarch and ascending aortic surgery.
Aortic arch and hemiarch surgery necessitate the temporary interruption of blood perfusion to the brain. Despite its complexity, hemiarch and ascending aortic surgery can be performed via a minimally invasive approach. Due to the higher risk of neurological injury during a circulatory arrest, several techniques were developed to further protect the brain during this surgery. We searched the Embase, Medline, and Cochrane databases and identified articles reporting outcomes of antegrade and retrograde cerebral perfusion strategies. Herein, we outline surgical approaches, intra-operative technical considerations, and clinical outcomes of hemiarch and ascending aortic surgery. Hemiarch and ascending aortic surgery is associated with a higher risk of mortality and morbidity. Attention to the optimal approach and cerebral protection strategy has been shown to significantly affect outcomes and mitigate risk.
Alnajar et al. (2020) studied this question.