Optimal brain protection in aortic arch surgery.
Parth Mukund PatelEdward Po-Chung ChenPublished in: Indian journal of thoracic and cardiovascular surgery (2021)
There is considerable debate with regard to the optimal cerebral protection strategy during aortic arch surgery. There are three contemporary techniques in use which include straight deep hypothermic circulatory arrest (DHCA), DHCA with retrograde cerebral perfusion (DHCA + RCP), and moderate hypothermic circulatory arrest with antegrade cerebral perfusion (MHCA + ACP). Appropriate application of these methods ensures appropriate cerebral, myocardial, and visceral protection. Each of these techniques has benefits and drawbacks and ensuring coordinated circulation management strategy is critical to safe performance of aortic arch surgery. In this report, we will review various cannulation strategies, review logistics of hypothermia, and review the relevant literature to outline the strengths and weaknesses of these various cerebral protection strategies.
Keyphrases
- subarachnoid hemorrhage
- minimally invasive
- coronary artery bypass
- cerebral ischemia
- brain injury
- extracorporeal membrane oxygenation
- surgical site infection
- systematic review
- cardiac arrest
- cell cycle
- type diabetes
- insulin resistance
- computed tomography
- metabolic syndrome
- heart failure
- contrast enhanced
- cerebral blood flow
- left ventricular
- multiple sclerosis
- percutaneous coronary intervention
- resting state
- magnetic resonance
- adipose tissue
- cell proliferation
- blood brain barrier
- skeletal muscle