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Review of cerebral perfusion strategies for aortic surgery with application for minimally invasive approaches
Author(s) -
Alnajar Ahmed,
Aleong Elizabeth F.,
Azhar Muhammad Z.,
Azarrafiy Ryan,
Lamelas Joseph
Publication year - 2020
Publication title -
journal of cardiac surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.428
H-Index - 58
eISSN - 1540-8191
pISSN - 0886-0440
DOI - 10.1111/jocs.15061
Subject(s) - medicine , cerebral perfusion pressure , aortic surgery , perfusion , deep hypothermic circulatory arrest , aortic arch , medline , surgery , anesthesia , cardiology , aorta , political science , law
Aortic arch and hemiarch surgery necessitate the temporary interruption of blood perfusion to the brain. Despite its complexity, hemiarch and ascending aortic surgery can be performed via a minimally invasive approach. Due to the higher risk of neurological injury during a circulatory arrest, several techniques were developed to further protect the brain during this surgery. We searched the Embase, Medline, and Cochrane databases and identified articles reporting outcomes of antegrade and retrograde cerebral perfusion strategies. Herein, we outline surgical approaches, intra‐operative technical considerations, and clinical outcomes of hemiarch and ascending aortic surgery. Hemiarch and ascending aortic surgery is associated with a higher risk of mortality and morbidity. Attention to the optimal approach and cerebral protection strategy has been shown to significantly affect outcomes and mitigate risk.