Aortic Arch Repair (Circulatory Arrest)

Aortic arch repair is a technically challenging surgery that requires collaboration between the anesthesiology, cardiac surgery, and perfusion teams. To accomplish a total aortic arch repair, blood flow to the brain and the rest of the body has to be interrupted. The most common aortic arch pathologies encountered for surgery are aortic arch aneurysms followed by aortic dissections. The need for hypothermia and circulatory arrest during aortic arch surgeries leads to unique implications for anesthetic management. Therefore, adequate knowledge of the planned surgery and specific surgical and nonsurgical cerebral protection techniques are necessary. Furthermore, an understanding of intraoperative neurophysiologic and temperature monitoring at deep hypothermia as well as postbypass coagulopathy management are needed in these challenging cases.