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Semin Thorac Cardiovasc Surg. 2019 Summer;31(2):146-152. doi: 10.1053/j.semtcvs.2019.01.001. Epub 2019 Jan 8.

Optimal Cerebral Protection Strategies in Aortic Surgery.

Author information

1
Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia.
2
Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia. Electronic address: edward.p.chen@emory.edu.

Abstract

Cerebral protection strategies in aortic surgery have undergone significant evolution over the years, but its tenets remain rooted in maintenance of hypothermia and cerebral perfusion to limit adverse neurologic outcomes. While deep hypothermic circulatory arrest alone remains a viable approach in many instances, the need for prolonged duration of circulatory arrest and increasing case complexity have driven the utilization of adjunctive cerebral perfusion strategies. In this review, we present the most recent studies published on this topic over the last few years investigating the efficacy of deep hypothermic circulatory arrest, retrograde cerebral perfusion, and unilateral and bilateral antegrade cerebral perfusion, as well as the emerging trend toward mild and moderate HCA temperatures. We highlight the ongoing controversies in the field that underscore the need for large-scale randomized trials using well-defined neurologic endpoints to optimize evidence-based practice in cerebral protection.

KEYWORDS:

Antegrade and retrograde cerebral perfusion; Cerebral protection; Deep hypothermic circulatory arrest; Moderate hypothermic circulatory arrest

PMID:
30633977
PMCID:
PMC6525653
[Available on 2020-07-01]
DOI:
10.1053/j.semtcvs.2019.01.001

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