Retrograde cerebral perfusion to support aortic arch repair.

IF 2.7

Expert review of medical devices Pub Date : 2025-09-07 DOI:10.1080/17434440.2025.2558203

Matti Jubouri, Mohamad Bashir, Mohammed Idhrees, Bashi Velayudhan, Ian M Williams, Damian M Bailey

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Abstract

Introduction: Acute type A aortic dissection (ATAAD) and aortic arch aneurysms are life-threatening conditions requiring complex surgical intervention, often involving circulatory arrest. Cerebral ischemia and neurological complications remain significant challenges in aortic arch surgery. This narrative review focuses on retrograde cerebral perfusion (RCP) techniques used to mitigate these risks.

Areas covered: This review article examines the evolution of cerebral protection strategies, with a focus on the techniques, parameters, and monitoring of RCP. It also compares RCP with antegrade cerebral perfusion (ACP) and deep hypothermic circulatory arrest (DHCA) regarding clinical outcomes.

Expert opinion: RCP has proven to be a valuable adjunct to DHCA in aortic arch surgery, offering comparable outcomes to ACP and demonstrating superiority over DHCA alone. Precise management of venous pressure and flow rate during RCP, along with meticulous cerebral monitoring, is crucial for optimizing neurological protection. Although ACP is increasingly favored in clinical practice, RCP continues to be a safe and effective cerebral protection strategy.

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逆行脑灌注支持主动脉弓修复。

急性A型主动脉夹层（ATAAD）和主动脉弓动脉瘤是危及生命的疾病，需要复杂的手术干预，通常涉及循环骤停。脑缺血和神经系统并发症仍然是主动脉弓手术的重大挑战。这篇叙述性综述的重点是逆行脑灌注（RCP）技术用于减轻这些风险。涵盖领域：这篇综述文章探讨了脑保护策略的演变，重点是RCP的技术、参数和监测。它还比较了RCP与顺行性脑灌注（ACP）和深度低温循环停止（DHCA）的临床结果。专家意见：RCP已被证明是主动脉弓手术中DHCA的一种有价值的辅助手段，其疗效与ACP相当，且优于单独DHCA。在RCP过程中，精确管理静脉压力和流速，以及细致的大脑监测，对于优化神经保护至关重要。尽管ACP在临床实践中越来越受到青睐，但RCP仍然是一种安全有效的脑保护策略。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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Expert review of medical devices

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