Optimal Cerebral Protection Strategies in Aortic Surgery
Publication date: Available online 8 January 2019
Source: Seminars in Thoracic and Cardiovascular Surgery
Author(s): Xiaoying Lou, Edward P. Chen
Cerebral protection strategies in aortic surgery have undergone significant evolution over the years, but its tenets remain rooted in maintenance of hypothermia and cerebral perfusion to limit adverse neurologic outcomes. While deep hypothermic circulatory arrest (DHCA) alone remains a viable approach in many instances, the need for prolonged duration of circulatory arrest and increasing case complexity have driven the utilization of adjunctive cerebral perfusion strategies. In this review, we present the most recent studies published on this topic over the last few years investigating the efficacy of DHCA, retrograde cerebral perfusion (RCP), and unilateral and bilateral antegrade cerebral perfusion (ACP), as well as the emerging trend towards mild and moderate HCA temperatures. We highlight the ongoing controversies in the field that underscore the need for large-scale randomized trials using well-defined neurological endpoints to optimize evidence-based practice in cerebral protection.