Aortic Institute, Yale-New Haven Hospital, New Haven, Connecticut, USA; ; Department of Surgical Diseases No. 2, Kazan State Medical University, Kazan, Russia.
Ann Cardiothorac Surg. 2013 May;2(3):303-15. doi: 10.3978/j.issn.2225-319X.2013.01.05.
Effective cerebral protection remains the principle concern during aortic arch surgery. Hypothermic circulatory arrest (HCA) is entrenched as the primary neuroprotection mechanism since the 70s, as it slows injury-inducing pathways by limiting cerebral metabolism. However, increases in HCA duration has been associated with poorer neurological outcomes, necessitating the adjunctive use of antegrade (ACP) and retrograde cerebral perfusion (RCP). ACP has superseded RCP as the preferred perfusion strategy as it most closely mimic physiological perfusion, although there exists uncertainty regarding several technical details, such as unilateral versus bilateral perfusion, flow rate and temperature, perfusion site, undue trauma to head vessels, and risks of embolization. Nevertheless, we believe that the convenience, simplicity and effectiveness of straight DHCA justifies its use in the majority of elective and emergency cases. The following perspective offers a historical and clinical comparison of the DHCA with other techniques of cerebral protection.
有效的脑保护仍然是主动脉弓手术中的主要关注点。自 70 年代以来，低温停循环（HCA）已成为主要的神经保护机制，因为它通过限制大脑代谢来减缓导致损伤的途径。然而，HCA 持续时间的增加与更差的神经学结果相关，因此需要辅助使用顺行（ACP）和逆行脑灌注（RCP）。ACP 已取代 RCP 成为首选的灌注策略，因为它最接近生理灌注，尽管在一些技术细节方面仍存在不确定性，例如单侧与双侧灌注、流量和温度、灌注部位、头部血管的不当创伤以及栓塞的风险。然而，我们认为，直接 DHCA 的便利性、简单性和有效性使其在大多数择期和急诊情况下都值得使用。以下观点从历史和临床角度对 DHCA 与其他脑保护技术进行了比较。
