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• W3136664513 abstract "Central MessageAortic arch surgery is high risk for neurologic injury. Intraoperative neurologic monitoring, hypothermic circulatory arrest, and cerebral perfusion are critical in mitigating these injuries.See Commentary on page 20.Neurologic injury remains one of the most-feared complications of aortic arch surgery. The reported incidence of postoperative stroke after acute type A aortic dissection ranges from 8.1% to 11.5%.1Tan M.E. Dossche K.M. Morshuis W.J. Kelder J.C. Waanders F.G. Schepens M.A. Is extended arch replacement for acute type A aortic dissection an additional risk factor for mortality?.Ann Thorac Surg. 2003; 76: 1209-1214Abstract Full Text Full Text PDF PubMed Scopus (50) Google Scholar, 2Tokuda Y. Miyata H. Motomura N. Oshima H. Usui A. Takamoto S. Brain protection during ascending aortic repair for Stanford type A acute aortic dissection surgery. Nationwide analysis in Japan.Circ J. 2014; 78: 2431-2438Crossref PubMed Scopus (38) Google Scholar, 3Pacini D. Murana G. Dimarco L. Berardi M. Mariani C. Coppola G. et al.Cerebral perfusion issues in type A aortic dissection.J Vis Surg. 2018; 4: 77Crossref PubMed Google Scholar Even in elective total-arch replacements, the stroke rate remains 3.5% to 8.6%.4Preventza O. Coselli J.S. Garcia A. Kashyap S. Akvan S. Simpson K.H. et al.Moderate hypothermia at warmer temperatures is safe in elective proximal and total arch surgery: results in 665 patients.J Thorac Cardiovasc Surg. 2017; 153: 1011-1018Abstract Full Text Full Text PDF PubMed Scopus (21) Google Scholar,5Okita Y. Miyata H. Motomura N. Takamoto S. Japan Cardiovascular Surgery Database OrganizationA study of brain protection during total arch replacement comparing antegrade cerebral perfusion versus hypothermic circulatory arrest, with or without retrograde cerebral perfusion: analysis based on the Japan Adult Cardiovascular Surgery database.J Thorac Cardiovasc Surg. 2015; 149: S65-S73Abstract Full Text Full Text PDF PubMed Scopus (91) Google Scholar At high-volume centers, excellent outcomes are possible. In a series of 114 patients undergoing elective ascending aortic replacement (11% total arch replacement, 75% hemiarch replacement), a <1% stroke rate was reported.6Aalaei-Andabili S.H. Martin T. Hess P. Lee T. Arnaoutakis G. Beaver T.M. Even redo ascending aorta replacement has low mortality in elective setting.J Cardiovasc Surg (Torino). 2019; 60: 150-152PubMed Google Scholar Despite the morbidity of these complications, prospective studies on strategies to mitigate this complication are limited, with retrospective reviews and expert opinion comprising much of the available literature. Over time, hypothermic circulatory arrest (HCA) with or without cerebral perfusion, neurophysiologic intraoperative monitoring, and pharmacologic adjuncts have become the mainstays of avoiding neurologic injury during aortic arch surgery (Figure 1).Figure 1Key components of neuroprotection during surgery on the aortic arch. Hypothermia with or without cerebral perfusion, neurophysiological intraoperative monitoring, and pharmacologic adjuncts have emerged as mainstays of neurological protection during aortic arch surgery.View Large Image Figure ViewerDownload (PPT)HCA in aortic arch replacement was first described by Griepp and colleagues7Griepp R.B. Stinson E.B. Hollingsworth J.F. Buehler D. Prosthetic replacement of the aortic arch.J Thorac Cardiovasc Surg. 1975; 70: 1051-1063Abstract Full Text PDF PubMed Google Scholar in a series of 4 patients. Patients were cooled to an average esophageal temperature of 14°C, and cerebral ischemia time was on average 43 minutes, with no neurologic injuries. HCA to varying degrees has subsequently become a mainstay of aortic arch surgery.8Griepp R.B. Di Luozzo G. Hypothermia for aortic surgery.J Thorac Cardiovasc Surg. 2013; 145: S56-S58Abstract Full Text Full Text PDF PubMed Scopus (47) Google Scholar,9Parikh N. Trimarchi S. Gleason T.G. Kamman A.V. di Eusanio M. Myrmel T. et al.Changes in operative strategy for patients enrolled in the International Registry of Acute Aortic Dissection interventional cohort program.J Thorac Cardiovasc Surg. 2017; 153: S74-S79Abstract Full Text Full Text PDF PubMed Scopus (51) Google ScholarStrategies for improving mortality and preventing neurologic injury have evolved over time. An International Registry for Aortic Dissection study examining acute ascending aortic dissection between 1996 and 2016 demonstrated an increase in the use of antegrade cerebral perfusion (ACP) and axillary arterial perfusion and a decrease in femoral artery cannulation, with a significant decrease in-hospital mortality from 17.5% to 12.2%, although neurologic outcomes were not reported.9Parikh N. Trimarchi S. Gleason T.G. Kamman A.V. di Eusanio M. Myrmel T. et al.Changes in operative strategy for patients enrolled in the International Registry of Acute Aortic Dissection interventional cohort program.J Thorac Cardiovasc Surg. 2017; 153: S74-S79Abstract Full Text Full Text PDF PubMed Scopus (51) Google ScholarNeurophysiological Intraoperative Monitoring (NIOM)Various modalities have been implemented over the years to monitor the adequacy of HCA and cerebral perfusion. Prospective data remain limited, and there are no convincing studies comparing monitoring techniques. Cerebral oximetry by near-infrared spectroscopy (NIRS) and bispectral index (BIS), a continuous output of dual-channel electroencephalography (EEG) data processed through a proprietary algorithm, remain the most frequently used modalities.Historically, multichannel EEG was used most frequently, but this has been widely replaced by BIS (Covidien, Boulder, Colo).10Fedorow C. Grocott H.P. Cerebral monitoring to optimize outcomes after cardiac surgery.Curr Opin Anaesthesiol. 2010; 23: 89-94Crossref PubMed Scopus (54) Google Scholar BIS only monitors the frontal cerebral regions, in contrast to traditional multichannel EEG, and its use relies on the extrapolation that the frontal regions reflect the posterior circulation. Although BIS has not been extensively validated in the detection of cerebral ischemia, it is now frequently used and arguably more reliable to apply.11Kertai M.D. Whitlock E.L. Avidan M.S. Brain monitoring with electroencephalography and the electroencephalogram-derived bispectral index during cardiac surgery.Anesth Analg. 2012; 114: 533-546Crossref PubMed Scopus (59) Google Scholar Observational studies have demonstrated that BIS decreases to 0 at varying rates between patients with deep hypothermia.12Hayashida M. Sekiyama H. Orii R. Chizei M. Ogawa M. Arita H. et al.Effects of deep hypothermic circulatory arrest with retrograde cerebral perfusion on electroencephalographic bispectral index and suppression ratio.J Cardiothorac Vasc Anesth. 2007; 21: 61-67Abstract Full Text Full Text PDF PubMed Scopus (28) Google Scholar Because both EEG and BIS are strongly influenced by anesthetic agents (and are indeed used to monitor depth of anesthesia), it is important to assess the baseline readings after the induction of anesthesia and before systemic cooling. As the brain is cooled, EEG serves as a measure of cerebral metabolic activity until electrocerebral inactivity is achieved. At our center and others, a BIS reading of zero or near zero guides when deep hypothermic circulatory arrest (DHCA) can be initiated. Anesthetics are often discontinued during the cooling process to avoid EEG misinterpretation during hypothermia.13Bergeron E.J. Mosca M.S. Aftab M. Justison G. Reece T.B. Neuroprotection strategies in aortic surgery.Cardiol Clin. 2017; 35: 453-465Abstract Full Text Full Text PDF PubMed Scopus (11) Google Scholar Bavaria and colleagues14Bavaria J. Pochettino A. Brinster D.R. Gorman R.C. McGarvey M.L. Gorman J.L. et al.New paradigms and improved results for the surgical treatment of acute type A dissection.Ann Surg. 2001; 234 (discussion 342-3): 336-342Crossref PubMed Scopus (130) Google Scholar demonstrated that most patients achieve EEG silence after 45 minutes of active cooling and that this duration (reaching nasopharyngeal temperature between 15°C and 20°C) is generally sufficient in the absence of EEG data.Cerebral oximetry has been widely adapted over the years. Historically, jugular bulb desaturation by invasive monitors was correlated with clinical outcomes, but logistical issues prevented the technique from becoming widespread, and the use of cerebral oximetry by NIRS has evolved as a surrogate.10Fedorow C. Grocott H.P. Cerebral monitoring to optimize outcomes after cardiac surgery.Curr Opin Anaesthesiol. 2010; 23: 89-94Crossref PubMed Scopus (54) Google Scholar Desaturations measured by NIRS intraoperatively have been linked to postoperative neurologic injury.15Zheng F. Sheinberg R. Yee M.S. Ono M. Zheng Y. Hogue C.W. Cerebral near-infrared spectroscopy monitoring and neurologic outcomes in adult cardiac surgery patients: a systematic review.Anesth Analg. 2013; 116: 663-676Crossref PubMed Scopus (208) Google Scholar Although there are a lack of randomized data supporting its use, cerebral oximetry is widely used and is an important tool in the aortic surgery team's armamentarium, which can be used to help guide perfusion and cooling strategies.Cerebral oximetry, as well as EEG or BIS, can help monitor cerebral perfusion in patients with aortic dissection to identify dynamic flaps or cannulas that become malpositioned intraoperatively. In addition, data obtained by NIRS, BIS, or EEG may suggest inadequate contralateral cerebral perfusion in cases performed under unilateral cerebral perfusion, as with patients lacking an intact circle of Willis.13Bergeron E.J. Mosca M.S. Aftab M. Justison G. Reece T.B. Neuroprotection strategies in aortic surgery.Cardiol Clin. 2017; 35: 453-465Abstract Full Text Full Text PDF PubMed Scopus (11) Google Scholar A study of 71 cases performed under moderate hypothermic circulatory arrest (MHCA) with ACP found that immediately after circulatory arrest, 45% of patients had an abrupt loss of electrocerebral activity, suggesting cerebral ischemia.16Keenan J.E. Wang H. Ganapathi A.M. Englum B.R. Kale E. Matthew J.P. et al.Electroencephalography during hemiarch replacement with moderate hypothermic circulatory arrest.Ann Thorac Surg. 2016; 101: 631-637Abstract Full Text Full Text PDF PubMed Scopus (17) Google Scholar This activity was restored with rapid initiation of unilateral ACP in most patients, but one required bilateral ACP to restore electrocerebral activity and another was placed back on cardiopulmonary bypass for further cooling. Although outcomes within patients in this study were equivalent, this experience highlights the need for careful NIOM when using moderate hypothermia and unilateral ACP.16Keenan J.E. Wang H. Ganapathi A.M. Englum B.R. Kale E. Matthew J.P. et al.Electroencephalography during hemiarch replacement with moderate hypothermic circulatory arrest.Ann Thorac Surg. 2016; 101: 631-637Abstract Full Text Full Text PDF PubMed Scopus (17) Google ScholarSomatosensory-evoked potentials (SEPs) are another modality that is sometimes used, but evidence for the application of this technology is limited. As with EEG, SEPs can be monitored during the cooling process to help assess when cerebral metabolic activity is suppressed, and it can also be used to localize intraoperative neurologic injury and possibly lead to corrective measures.13Bergeron E.J. Mosca M.S. Aftab M. Justison G. Reece T.B. Neuroprotection strategies in aortic surgery.Cardiol Clin. 2017; 35: 453-465Abstract Full Text Full Text PDF PubMed Scopus (11) Google Scholar Recently, a review of 224 cases using multimodal NIOM (NIRS, SEP, EEG) found good correlation between NIOM abnormalities and stroke. However, desaturation by NIRS did not correlate with stroke, suggesting NIRS assesses different pathology than EEG and SEP.17Ghincea C.V. Anderson D.A. Ikeno Y. Roda G.F. Eldeiry M. Bronsert M.R. et al.Utility of neuromonitoring in hypothermic circulatory arrest cases for early detection of stroke: listening through the noise.J Thorac Cardiovasc Surg. February 19, 2020; ([Epub ahead of print])Abstract Full Text Full Text PDF PubMed Scopus (5) Google Scholar In another institution, implementation of an acute type A aortic dissection protocol, in which all patients underwent continuous EEG and SEP monitoring, allowed for surgeons to perform immediate intraoperative adjustment of perfusion cannulas as needed; in this series, 15% of cases had intraoperative changes. In this study, neuromonitoring abnormalities prompted postoperative imaging studies and catheter-based neurointerventions when appropriate, although neither the frequency of these interventions nor the reversibility of presumed neurologic insult were discussed. Postoperative stroke rates of 3.6% and 3.3% were seen for hemiarch and total arch replacements, respectively, which are much lower than other published studies.18Trivedi D. Navid F. Balzer J.R. Rama J. Lacomis J.M. Jovin T.G. et al.Aggressive aortic arch and carotid replacement strategy for type A aortic dissection improves neurologic outcomes.Ann Thorac Surg. 2016; 101 (discussion 903-5): 896-903Abstract Full Text Full Text PDF PubMed Scopus (65) Google ScholarHypothermia and Cerebral PerfusionHypothermia is the mainstay for cerebral protection during circulatory arrest, as it reduces metabolic demand. Stecker and colleagues19Stecker M.M. Cheung A.T. Pochettino A. Kent G.P. Patterson T. Weiss S.J. et al.Deep hypothermic circulatory arrest: I. Effects of cooling on electroencephalogram and evoked potentials.Ann Thorac Surg. 2001; 71: 14-21Abstract Full Text Full Text PDF PubMed Scopus (233) Google Scholar demonstrated electroencephalogram burst-suppression in humans at nasopharyngeal temperatures of 24.4°C ± 4°C, with electrocerebral silence at 17.8°C ± 4°C. Deep hypothermia is commonly accepted as circulatory arrest temperatures of 14.1°C to 20°C and moderate hypothermia as 20.1°C to 28°C.20Tian D.H. Wan B. Bannon P.G. Misfeld M. LeMaire S.A. Kazui T. et al.A meta-analysis of deep hypothermic circulatory arrest versus moderate hypothermic circulatory arrest with selective antegrade cerebral perfusion.Ann Cardiothorac Surg. 2013; 2: 148-158Crossref PubMed Google Scholar There is considerable variability in the site of temperature measurement, whether nasopharyngeal, rectal, or bladder measurements are used.19Stecker M.M. Cheung A.T. Pochettino A. Kent G.P. Patterson T. Weiss S.J. et al.Deep hypothermic circulatory arrest: I. Effects of cooling on electroencephalogram and evoked potentials.Ann Thorac Surg. 2001; 71: 14-21Abstract Full Text Full Text PDF PubMed Scopus (233) Google Scholar Although HCA is often combined with either antegrade or retrograde cerebral perfusion, DHCA alone has been shown to be a safe approach at many centers. Ziganshin and colleagues21Ziganshin B.A. Rajbanshi B.G. Tranquilli M. Fang H. Rizzo J.A. Elefteriades J.A. Straight deep hypothermic circulatory arrest for cerebral protection during aortic arch surgery: safe and effective.J Thorac Cardiovasc Surg. 2014; 148 (discussion 898-900): 888-898Abstract Full Text Full Text PDF PubMed Scopus (83) Google Scholar reported acceptable mortality and stroke rates with DHCA as their sole cerebral protective strategy, with mean bladder temperatures of 18.7°C and DHCA times of up to 50 minutes. Beyond 50 minutes, the observed stroke rate climbed from 1.3% to 16.7%. The maximum safe duration of DHCA when used as the sole neuroprotective strategy is contested, but rates of neurologic injury begin to climb between 25 and 60 minutes.22Gupta P. Harky A. Jahangeer S. Adams B. Bashir M. Varying evidence on deep hypothermic circulatory arrest in thoracic aortic aneurysm surgery.Tex Heart Inst J. 2018; 45: 70-75Crossref PubMed Scopus (25) Google Scholar The German Registry for Acute Aortic Dissection Type A (GERAADA) has subsequently corroborated this limit—mortality rates began to climb when HCA alone (without any cerebral perfusion) exceeded 30 minutes.23Boening A. Karck M. Cozelman L.O. Easo J. Kruger T. Rylski B. et al.German Registry for Acute Aortic Dissection Type A: structure, results, and future perspectives.Thorac Cardiovasc Surg. 2017; 65: 77-84PubMed Google ScholarTwo strategies have emerged for arch reconstructions requiring longer HCA times: (1) moderate hypothermic circulatory arrest with antegrade cerebral perfusion (MHCA + ACP), or (2) deep hypothermic circulatory arrest with retrograde cerebral perfusion (DHCA + RCP). Studies in animals have demonstrated superior metabolic support from ACP as compared with RCP during DHCA (15°C).24Filgueiras C.L. Winsborrow B. Ye J. Scott J. Aronov A. Koslowski P. et al.A 31p-magnetic resonance study of antegrade and retrograde cerebral perfusion during aortic arch surgery in pigs.J Thorac Cardiovasc Surg. 1995; 110: 55-62Abstract Full Text PDF PubMed Scopus (59) Google Scholar Under moderate HCA (28°C), studies in animals demonstrated that RCP does not support cerebral metabolic demands; however, advocates of retrograde cerebral perfusion highlight that retrograde perfusion can flush out air and particulate emboli.25Filgueiras C.L. Ryner L. Ye J. Yang L. Ede M. Sun J. et al.Cerebral protection during moderate hypothermic circulatory arrest: histopathology and magnetic resonance spectroscopy of brain energetics and intracellular pH in pigs.J Thorac Cardiovasc Surg. 1996; 112: 1073-1080Abstract Full Text Full Text PDF PubMed Scopus (33) Google ScholarA 2013 meta-analysis of 1783 patients undergoing aortic arch surgery compared DHCA alone with MHCA + ACP. This study found DHCA without any cerebral perfusion was associated with significantly more permanent neurologic deficits (12.8% vs 7.3%, P = .0007), defined as stroke or coma.20Tian D.H. Wan B. Bannon P.G. Misfeld M. LeMaire S.A. Kazui T. et al.A meta-analysis of deep hypothermic circulatory arrest versus moderate hypothermic circulatory arrest with selective antegrade cerebral perfusion.Ann Cardiothorac Surg. 2013; 2: 148-158Crossref PubMed Google Scholar No differences were found in mortality or temporary neurologic deficit, and median circulatory arrest times were not analyzed in the meta-analysis but averaged 30 to 40 minutes. In general, there has been a shift toward the use of moderate HCA with ACP (often via axillary perfusion) for longer-duration cases.The degree of hypothermia remains a point of contention, as deeper hypothermia requires longer rewarming times and is associated with acquired coagulopathy. A study of 377 patients undergoing ascending aortic repair (with or without arch repair) with ACP under moderate (25°C-28°C) or deep (20°C-24.9°C) HCA demonstrated no difference in stroke, temporary neurologic dysfunction, or in-hospital death.26Kamiya H. Hagl C. Kropivnitskaya I. Bothig D. Kallenbach K. Khaladj N. et al.The safety of moderate hypothermic lower body circulatory arrest with selective cerebral perfusion: a propensity score analysis.J Thorac Cardiovasc Surg. 2007; 133: 501-509Abstract Full Text Full Text PDF PubMed Scopus (186) Google Scholar However, lower temperature was significantly associated with reoperation for bleeding and greater markers of postoperative inflammatory response.Adding retrograde cerebral perfusion to DHCA has shown equivalent results to ACP with MHCA. A series of 376 patients undergoing hemiarch reconstruction for nondissecting disease, with short (average 22 minutes) HCA times, compared MHCA + ACP with DHCA + RCP and found no difference in 30-day mortality or stroke. However, MHCA + ACP was associated with shorter crossclamp and cardiopulmonary bypass times, as well as decreased transfusion requirements.27Vallabhajosyula P. Jassar A.S. Menon R.S. Komlo C. Gutsche J. Desai N.D. et al.Moderate versus deep hypothermic circulatory arrest for elective aortic transverse hemiarch reconstruction.Ann Thorac Surg. 2015; 99: 1511-1517Abstract Full Text Full Text PDF PubMed Scopus (48) Google Scholar Similarly, a review of 8169 patients undergoing elective total arch replacement compared ACP (at 24.2°C) versus RCP (at 21.2°C) and found no difference in mortality, stroke, or transient neurologic disorder, although the use of lower temperatures with RCP was associated with longer intensive care unit length of stay.5Okita Y. Miyata H. Motomura N. Takamoto S. Japan Cardiovascular Surgery Database OrganizationA study of brain protection during total arch replacement comparing antegrade cerebral perfusion versus hypothermic circulatory arrest, with or without retrograde cerebral perfusion: analysis based on the Japan Adult Cardiovascular Surgery database.J Thorac Cardiovasc Surg. 2015; 149: S65-S73Abstract Full Text Full Text PDF PubMed Scopus (91) Google ScholarA recent small prospective study of 20 patients undergoing elective hemiarch replacement randomized patients to either DHCA + RCP (14.1°C-20°C) or MHCA + ACP (20°C-28°C) and found no differences in crossclamp, cardiopulmonary bypass, or HCA times. Clinical outcomes including stroke, transient ischemic attack, transient neurologic dysfunction, neurologic assessment by a neurologist, and neurocognitive deficits as assessed by a computerized cognitive assessment were all equivalent. However, magnetic resonance imaging (MRI) showed ischemic lesions in 100% of patients in the MHCA + ACP group, but only 45% of the DHCA + RCP group had lesions. Notably, the MRI findings were not detected by clinical neurologic examination or neurocognitive testing. The authors suggest the increased MRI findings could be due to either manipulation and clamping of the innominate or carotid vessels during cannulation for ACP or due to fundamental differences in embolic events between ACP and RCP.28Leshnower B.G. Rangaraju S. Allen J.W. Stringer A.Y. Gleason T.G. Chen E.P. Deep hypothermia with retrograde cerebral perfusion versus moderate hypothermia with antegrade cerebral perfusion for arch surgery.Ann Thorac Surg. 2019; 107: 1104-1110Abstract Full Text Full Text PDF PubMed Scopus (36) Google Scholar These differences would support the use of RCP with deep HCA, but widespread adaptation for all aortic arch operations is limited by the commonly accepted notion that RCP offers less metabolic support for longer procedures, although circulatory arrest times in this study were short (19-21 minutes on average).5Okita Y. Miyata H. Motomura N. Takamoto S. Japan Cardiovascular Surgery Database OrganizationA study of brain protection during total arch replacement comparing antegrade cerebral perfusion versus hypothermic circulatory arrest, with or without retrograde cerebral perfusion: analysis based on the Japan Adult Cardiovascular Surgery database.J Thorac Cardiovasc Surg. 2015; 149: S65-S73Abstract Full Text Full Text PDF PubMed Scopus (91) Google Scholar,29Griepp R.B. Bonser R. Haverich A. Panel discussion: session II—aortic arch.Ann Thorac Surg. 2007; 83: S824-S831Abstract Full Text Full Text PDF Scopus (10) Google ScholarGiven the variability in patient population, disease type, circulatory arrest times, and even target temperatures between studies comparing hypothermia and perfusion strategies, relative outcomes are difficult to extrapolate to different populations, and trends must be identified from studies. DHCA alone has been demonstrated to be safe for short circulatory arrest times, but between 25 and 50 minutes, neurologic injury and mortality rates begin to climb. In general, expert opinion has favored using DHCA with RCP for intermediate duration cases due to ease of cannulation and theoretical retrograde flushing of embolic debris, while relying on either DHCA or MHCA combined with ACP for longer cases due to superior metabolic support.29Griepp R.B. Bonser R. Haverich A. Panel discussion: session II—aortic arch.Ann Thorac Surg. 2007; 83: S824-S831Abstract Full Text Full Text PDF Scopus (10) Google Scholar,30Ryldki B. Urbanski P.P. Siepe M. Beyersdorf F. Bachet J. Gleason T.G. et al.Operative techniques in patients with type A dissection complicated by cerebral malperfusion.Eur J Cardiothorac Surg. 2014; 46: 156-166Crossref PubMed Scopus (41) Google Scholar These neuroprotective strategies are summarized in Table 1.Table 1Neuroprotective strategies for aortic arch surgery comparedNeuroprotection strategyHypothermic circulatory arrest timeAdvantagesDisadvantagesDHCA aloneShort (<25-50 min)•Ease of use•Equivalent outcomes for short cases21Ziganshin B.A. Rajbanshi B.G. Tranquilli M. Fang H. Rizzo J.A. Elefteriades J.A. Straight deep hypothermic circulatory arrest for cerebral protection during aortic arch surgery: safe and effective.J Thorac Cardiovasc Surg. 2014; 148 (discussion 898-900): 888-898Abstract Full Text Full Text PDF PubMed Scopus (83) Google Scholar•Increased neurologic dysfunction beyond 25-50 min20Tian D.H. Wan B. Bannon P.G. Misfeld M. LeMaire S.A. Kazui T. et al.A meta-analysis of deep hypothermic circulatory arrest versus moderate hypothermic circulatory arrest with selective antegrade cerebral perfusion.Ann Cardiothorac Surg. 2013; 2: 148-158Crossref PubMed Google Scholar,22Gupta P. Harky A. Jahangeer S. Adams B. Bashir M. Varying evidence on deep hypothermic circulatory arrest in thoracic aortic aneurysm surgery.Tex Heart Inst J. 2018; 45: 70-75Crossref PubMed Scopus (25) Google Scholar,23Boening A. Karck M. Cozelman L.O. Easo J. Kruger T. Rylski B. et al.German Registry for Acute Aortic Dissection Type A: structure, results, and future perspectives.Thorac Cardiovasc Surg. 2017; 65: 77-84PubMed Google Scholar•Increased cooling times•Possibly greater reoperation rates for bleeding26Kamiya H. Hagl C. Kropivnitskaya I. Bothig D. Kallenbach K. Khaladj N. et al.The safety of moderate hypothermic lower body circulatory arrest with selective cerebral perfusion: a propensity score analysis.J Thorac Cardiovasc Surg. 2007; 133: 501-509Abstract Full Text Full Text PDF PubMed Scopus (186) Google ScholarDHCA + RCPIntermediate (25-50 min)•Equivalent clinical neurologic outcomes5Okita Y. Miyata H. Motomura N. Takamoto S. Japan Cardiovascular Surgery Database OrganizationA study of brain protection during total arch replacement comparing antegrade cerebral perfusion versus hypothermic circulatory arrest, with or without retrograde cerebral perfusion: analysis based on the Japan Adult Cardiovascular Surgery database.J Thorac Cardiovasc Surg. 2015; 149: S65-S73Abstract Full Text Full Text PDF PubMed Scopus (91) Google Scholar,28Leshnower B.G. Rangaraju S. Allen J.W. Stringer A.Y. Gleason T.G. Chen E.P. Deep hypothermia with retrograde cerebral perfusion versus moderate hypothermia with antegrade cerebral perfusion for arch surgery.Ann Thorac Surg. 2019; 107: 1104-1110Abstract Full Text Full Text PDF PubMed Scopus (36) Google Scholar•Fewer cerebral lesions detected by MRI—possible retrograde flushing of debris28Leshnower B.G. Rangaraju S. Allen J.W. Stringer A.Y. Gleason T.G. Chen E.P. Deep hypothermia with retrograde cerebral perfusion versus moderate hypothermia with antegrade cerebral perfusion for arch surgery.Ann Thorac Surg. 2019; 107: 1104-1110Abstract Full Text Full Text PDF PubMed Scopus (36) Google Scholar•Longer ICU length of stay5Okita Y. Miyata H. Motomura N. Takamoto S. Japan Cardiovascular Surgery Database OrganizationA study of brain protection during total arch replacement comparing antegrade cerebral perfusion versus hypothermic circulatory arrest, with or without retrograde cerebral perfusion: analysis based on the Japan Adult Cardiovascular Surgery database.J Thorac Cardiovasc Surg. 2015; 149: S65-S73Abstract Full Text Full Text PDF PubMed Scopus (91) Google Scholar•Possibly greater reoperation rates for bleeding26Kamiya H. Hagl C. Kropivnitskaya I. Bothig D. Kallenbach K. Khaladj N. et al.The safety of moderate hypothermic lower body circulatory arrest with selective cerebral perfusion: a propensity score analysis.J Thorac Cardiovasc Surg. 2007; 133: 501-509Abstract Full Text Full Text PDF PubMed Scopus (186) Google ScholarDHCA + ACP–•Equivalent clinical neurologic outcomes26Kamiya H. Hagl C. Kropivnitskaya I. Bothig D. Kallenbach K. Khaladj N. et al.The safety of moderate hypothermic lower body circulatory arrest with selective cerebral perfusion: a propensity score analysis.J Thorac Cardiovasc Surg. 2007; 133: 501-509Abstract Full Text Full Text PDF PubMed Scopus (186) Google Scholar•Increased risk of reoperation for bleeding26Kamiya H. Hagl C. Kropivnitskaya I. Bothig D. Kallenbach K. Khaladj N. et al.The safety of moderate hypothermic lower body circulatory arrest with selective cerebral perfusion: a propensity score analysis.J Thorac Cardiovasc Surg. 2007; 133: 501-509Abstract Full Text Full Text PDF PubMed Scopus (186) Google ScholarMHCA + ACPIntermediate or long (>25 min)•Equivalent clinical neurologic outcomes26Kamiya H. Hagl C. Kropivnitskaya I. Bothig D. Kallenbach K. Khaladj N. et al.The safety of moderate hypothermic lower body circulatory arrest with selective cerebral perfusion: a propensity score analysis.J Thorac Cardiovasc Surg. 2007; 133: 501-509Abstract Full Text Full Text PDF PubMed Scopus (186) Google Scholar,27Vallabhajosyula P. Jassar A.S. Menon R.S. Komlo C. Gutsche J. Desai N.D. et al.Moderate versus deep hypothermic circulatory arrest for elective aortic transverse hemiarch reconstruction.Ann Thorac Surg. 2015; 99: 1511-1517Abstract Full Text Full Text PDF PubMed Scopus (48) Google Scholar•Shorter crossclamp times, transfusion requirements, and bypass times27Vallabhajosyula P. Jassar A.S. Menon R.S. Komlo C. Gutsche J. Desai N.D. et al.Moderate versus deep hypothermic circulatory arrest for elective aortic transverse hemiarch reconstruction.Ann Thorac Surg. 2015; 99: 1511-1517Abstract Full Text Full Text PDF PubMed Scopus (48) Google Scholar•May require bilateral ACP, based on intraoperative neuromonitoring•Greater inci" @default.
• W3136664513 created "2021-03-29" @default.
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• W3136664513 date "2021-06-01" @default.
• W3136664513 modified "2023-09-30" @default.
• W3136664513 title "Neuromonitoring and neuroprotection advances for aortic arch surgery" @default.
• W3136664513 cites W1895460150 @default.
• W3136664513 cites W1899065124 @default.
• W3136664513 cites W1965134223 @default.
• W3136664513 cites W1965398595 @default.
• W3136664513 cites W1973504264 @default.
• W3136664513 cites W1983252174 @default.
• W3136664513 cites W1996739142 @default.
• W3136664513 cites W2004329952 @default.
• W3136664513 cites W2016668870 @default.
• W3136664513 cites W2019541577 @default.
• W3136664513 cites W2021389315 @default.
• W3136664513 cites W2045650846 @default.
• W3136664513 cites W2050433734 @default.
• W3136664513 cites W2057212907 @default.
• W3136664513 cites W2088475301 @default.
• W3136664513 cites W2089457700 @default.
• W3136664513 cites W2090153967 @default.
• W3136664513 cites W2094140196 @default.
• W3136664513 cites W2115469094 @default.
• W3136664513 cites W2117240640 @default.
• W3136664513 cites W2123491092 @default.
• W3136664513 cites W2133003685 @default.
• W3136664513 cites W2142975250 @default.
• W3136664513 cites W2151351508 @default.
• W3136664513 cites W2158298852 @default.
• W3136664513 cites W2172161157 @default.
• W3136664513 cites W2331045460 @default.
• W3136664513 cites W2522932808 @default.
• W3136664513 cites W2567981674 @default.
• W3136664513 cites W2593301152 @default.
• W3136664513 cites W2619044380 @default.
• W3136664513 cites W2621691645 @default.
• W3136664513 cites W2799467836 @default.
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