Multimodal protocol influence on stroke and neurocognitive deficit prevention after ascending/arch aortic operations

2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM Guidelines for the Diagnosis and Management of Patients With Thoracic Aortic Disease

“…The false lumen may thrombose over time ( Figure 19). While on noninvasive imaging, 15% of patients with aortic dissection syndromes have an apparent IMH without evidence of an intimal tear, autopsy studies show only 4% have no visible intimal tear; indeed, at the time of surgery a tear is found in most patients (210,211). Occasionally, AoD originates from a small atheromatous ulcer that is difficult to identify.…”

“…Brain protection can be achieved by profound hypothermia alone, direct antegrade perfusion of 1 or more of the brachiocephalic arteries, or retrograde perfusion using cold oxygenated blood that is infused into the superior vena cava during the arrest period (211,449,(462)(463)(464)(465)(466)(467) (see Section 14.5.1). The aortic arch is replaced with a synthetic graft.…”

“…Protection of the brain involves ensuring that calcium plaques or atheromata are not disturbed to prevent brain embolization. The temperature and where it is best measured, at which circulatory arrest is commenced, are debated but most large series have recommended circulatory arrest at a temperature below 20°C (211).…”

Cannulation of the innominate artery during surgery of the thoracic aorta: our experience in 55 patients

“…It has been suggested that PNDs result from embolization of the brain and TNDs from inadequate methods of brain protection [6]. Therefore, in the last decade, the usage of ACP together with the selection of central cannulation sites such as the ascending aorta and the axillary artery by reducing the brain embolic risk have resulted in improved hospital mortality and neurologic outcome in patients undergoing surgery of the thoracic aorta [7][8][9][10][11].…”

An Australian Experience with Aortic Arch Replacement: A Novel Approach without Circulatory Arrest or Deep Hypothermia

“…These are the very cases when the myocardium is most at risk. Notwithstanding this, peri-operative myocardial dysfunction carries a high morbidity and mortality price [8,9].…”