Unilateral Antegrade Cerebral Perfusion during Aortic Arch Repair

Abstract

Circulatory arrest is one of the most crucial timeframes during aortic arch surgery due to the increased ischemic risk for inner organs, including the brain. In this regard, the issue of intraoperative cerebral protection is of great importance. Despite the fact that antegrade cerebral perfusion is the preferred neuroprotective strategy during aortic arch surgery, including the frozen elephant trunk procedure, the choice of the best perfusion technique for cerebral protection is still a matter of debate. We conducted a comprehensive analysis of cerebral status in 97 patients who underwent total arch repair using the frozen elephant trunk technique under moderate hypothermia and unilateral cerebral perfusion via an innominate artery. Our analysis, including intraoperative monitoring of cerebral oximetry, the incidence of postoperative neurological deficit and cognitive impairment, and added assessment of a neuronal injury marker level (neuron-specific enolase), demonstrates the high efficacy and safety of unilateral antegrade cerebral perfusion via an innominate artery.