Antegrade Selective Cerebral Perfusion - How to Proceed?

Abstract

Aortic surgery still carries a high risk of brain damage that dominates postoperative morbidity and mortality. The concept and advantages of antegrade selective cerebral perfusion, which allows for numerous variations in its implementation, have been clearly seen for more than a decade now, but the preferred way of positioning remains unanswered. Ideal perfusion during ascending aorta/arch surgery should allow the easy implementation of selective antegrade cerebral perfusion while avoiding atheroembolization or false lumen perfusion during dissections.

Integrated Cerebral Protection Combined Antegrade and Retrograde Cerebral Perfusion during Deep Hypothermic Circulatory Arrest

“…1 ACP can be performed using axillary artery cannu-lation and innominate artery clamping during the period of circulatory arrest, by selectively cannulating the head vessels with balloon-tipped catheters or by perfusing a segment of a graft after it has been anastomosed to one or more of the brachiocephalic vessels. 9 Aortic arch surgery is relatively uncommon, and thus there is a distinct lack of good clinical evidence to define optimal routes of cerebral perfusion, perfusate and systemic temperature, and flow rates. 4,10 To date, all published studies examining cerebral perfusion adjuncts to HCA have compared RCP with ACP or with HCA alone.…”