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Cerebral protection strategies for type A aortic dissection repair

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Indian Journal of Thoracic and Cardiovascular Surgery Aims and scope Submit manuscript

Abstract

Importance

Techniques to preserve neurological function during type A aortic dissection repairs have been broadly discussed in the literature and heavily debated. Despite the effectiveness of various approaches, a consensus lacks on how to maintain optimal cerebral temperature during surgery. This review examines the three predominant cerebral protection strategies in aortic arch reconstructions: straight deep hypothermic circulatory arrest (sDHCA), retrograde cerebral perfusion (RCP), and antegrade cerebral perfusion (ACP).

Observations

The signature characteristics of sDHCA, RCP, and ACP are similar—hypothermia, with or without cerebral perfusion. Employing cerebral perfusion techniques may prolong operative times, while ACP permits operation at higher body temperatures, albeit with restricted operative durations.

Conclusion

For type A dissection arch reconstructions, sDHCA, RCP, and ACP can be successfully implemented. Factors such as operative times and individual patient conditions should be considered when choosing a cerebral protection strategy.

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N/A, all data is already available to share as our manuscript is a lit review.

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Author information

Authors and Affiliations

  1. Temple University, 1801 N Broad St, Philadelphia, PA, 19122, USA

    Faisal A. Shaikh

  2. Department of Surgery, Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, MI, USA

    Sarah I. Khalil

  3. Department of General Surgery, University of North Carolina Hospitals, Chapel Hill, NC, USA

    Erik H. Ander

  4. Lewis Katz School of Medicine, Temple University, Philadelphia, PA, USA

    Hannah R. Calvelli

  5. Department of Cardiothoracic Surgery, Temple University Hospital, Philadelphia, PA, USA

    Mohammed A. Kashem & Suyog A. Mokashi

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Contributions

Suyog A. Mokashi, MD, and Faisal A. Shaikh contribued to the idea of the article. Faisal A. Shaikh performed the literature search and wrote the first draft of the manuscript. Then, Faisal A. Shaikh, Sarah I. Khalil, MD, Erik H. Ander, MD, Hannah Calvelli, Mohammed A. Kashem, MD, and Suyog A. Mokashi, MD, added significant comments and edits to numerous versions of the manuscript. Faisal A. Shaikh made final changes and all the authors read/approved the final manuscript.

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Correspondence to Faisal A. Shaikh.

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Shaikh, F.A., Khalil, S.I., Ander, E.H. et al. Cerebral protection strategies for type A aortic dissection repair. Indian J Thorac Cardiovasc Surg 39 (Suppl 2), 308–314 (2023). https://doi.org/10.1007/s12055-023-01605-5

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