Brain Protection in Type A Aortic Dissection

Abstract

Due to the technical necessity to enter the aortic arch during surgery for aortic dissection type A, the brain must be protected optimally to avoid damage to our most precious organ. The different options are reviewed starting with deep hypothermic circulatory arrest which was the first technique described to protect the brain. Its major advantage is the bloodless surgical field and its simplicity but the time constraints limit its application in complex and extended repairs. Therefore antegrade cerebral perfusion has actually become much more popular because this technique allows for much longer arrest periods in which the brain is perfused in a physiological manner reducing the cerebral complications after surgery. Pros and cons of the existing techniques are discussed.