Evolution of cerebral perfusion techniques in type a aortic dissection surgery: a single center experience

Abstract

In patients operated on for AAAD, antegrade selective cerebral perfusion with moderate hypothermia is a significant factor in decreasing hospital mortality.

EndoClamp Aortic Catheter in the descending aorta for normothermic aortic arch replacement on the beating heart without circulatory arrest

“…2-4 Nowadays, antegrade selective cerebral perfusion with moderate hypothermic circulatory arrest is the most commonly used methodology for cerebral protection in aortic arch surgery. 5-8…”

“…[2][3][4] Nowadays, antegrade selective cerebral perfusion with moderate hypothermic circulatory arrest is the most commonly used methodology for cerebral protection in aortic arch surgery. [5][6][7][8] In order to reduce the side-effects due to hypothermic circulatory arrest, we propose normothermic beating heart surgery for the replacement of the aortic arch. In the reported case, after reconstruction of the cervical arterial branches, we perfused the cerebral circulation and the heart through a cannula in the ascending aorta.…”

German Registry for Acute Aortic Dissection Type A: Structure, Results, and Future Perspectives

“…Especially in those patients admitted with ND before surgery, neuroprotective strategies such as cooling, perfusion, or drugs must be established. 7,9 Longer times for HCA have been described as a risk factor for ND by Svensson et al 10 HCA without cerebral perfusion was a risk factor for ND in several publications, [11][12][13][14][15] while ND occurred similarly often after antegrade or retrograde cerebral perfusion. 16,17 Despite the fact that neuroprotective drugs have been inadequately investigated in patients with AADA (at least compared with cannulation or perfusion techniques), anesthesiologists find them effective.…”

Complacency is the enemy of innovation

“…The manuscript of Salah et al 1 describes a retrospective review of two cohorts of patients, reflecting a period of the uniform integration and deployment of antegrade cerebral perfusion and moderate hypothermia. In the earlier cohort, deep hypothermic circulatory arrest (DHCA) was routinely used with alternative means of cerebral protection (DHCA alone, retrograde cerebral perfusion or DHCA with antegrade cerebral perfusion).…”