Cerebral Protection in Aortic Arch Surgery: Hypothermia Alone Suffices

Cerebral protection has been the cornerstone of successful aortic arch surgery for almost 40 years. Aneurysms of the aortic arch are among the most challenging cases for surgical treatment and require procedural expertise for their safe conduct. Up to now, 3 main strategies for cerebral protection of patients undergoing extensive aortic surgery have been developed and studied. These are straight deep hypothermic circulatory arrest (DHCA), retrograde cerebral perfusion (RCP), and ante grade cerebral perfusion (ACP). Straight DHCA used to be the preferred technique; however, the recent trend among cardiothoracic surgeons is to avoid straight DHCA in favor of such adjunctive perfusion techniques as RCP or ACP. Therefore, the possible superiority of one of these 3 techniques has been an ongoing topic for debate.