title: Deep hypothermic circulatory arrest.
abstract: 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 ACP has superseded RCP as the preferred perfusion strategy as it most closely mimic physiological perfusion, although there exists uncertainty regarding several technical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.
authors: Aortic Institute, Yale-New Haven Hospital, New Haven, Connecticut, USA; ; Department of Surgical Diseases No. 2, Kazan State Medical University, Kazan, Russia.
authors: Bulat A
authors: BA
authors: Ziganshin
authors: John A
authors: JA
authors: Elefteriades
keywords: Deep hypothermic circulatory arrest; aortic arch surgery; cerebral perfusion; neuroprotection
references: J Thorac Cardiovasc Surg. 1975 Dec;70(6):1051-63
references: 1186283
references: Ann Thorac Surg. 2008 Sep;86(3):787-96; discussion 787-96
references: 18721563
references: J Thorac Cardiovasc Surg. 2008 Apr;135(4):908-14
references: 18374779
references: Ann Thorac Surg. 2002 Nov;74(5):S1848-52; discussion S1857-63
references: 12440679
references: Eur J Cardiothorac Surg. 2010 Sep;38(3):293-8
references: 20304662
references: Interact Cardiovasc Thorac Surg. 2009 Sep;9(3):426-30
references: 19502246
references: Ann Thorac Surg. 1999 Jun;67(6):1879-82; discussion 1891-4
references: 10391331
references: Asian Cardiovasc Thorac Ann. 2009 Oct;17(5):500-4
references: 19917793
references: Eur J Cardiothorac Surg. 2010 Jul;38(1):46-51
references: 20185324
references: J Thorac Cardiovasc Surg. 2003 Sep;126(3):638-44
references: 14502133
references: J Cardiothorac Vasc Anesth. 2010 Apr;24(2):316-21
references: 19646900
references: J Card Surg. 2002 Mar-Apr;17(2):115-24
references: 12220062
references: Ann Thorac Surg. 1994 Mar;57(3):669-76
references: 8147639
references: Circulation. 2011 Jul 26;124(4):434-43
references: 21747050
references: Surgery. 1953 Jan;33(1):52-9
references: 13015312
references: Ann Thorac Surg. 2010 Aug;90(2):547-54
references: 20667348
references: Ann Thorac Surg. 1997 Jun;63(6):1601-7
references: 9205156
references: Ann Thorac Surg. 2002 Aug;74(2):426-31; discussion 431
references: 12173824
references: Jpn J Thorac Cardiovasc Surg. 2001 Jun;49(6):337-42
references: 11481834
references: Cardiol Clin. 2010 May;28(2):371-9
references: 20452556
references: Surg Gynecol Obstet. 1955 Dec;101(6):667-72
references: 13274273
references: Ann Thorac Surg. 2001 Mar;71(3):1062-3; discussion 1064
references: 11269438
references: Ann Thorac Surg. 2011 Jun;91(6):1868-73
references: 21619985
references: Ann Thorac Surg. 1994 Apr;57(4):904-11
references: 8166539
references: Ann Thorac Surg. 1999 Jun;67(6):1887-90; discussion 1891-4
references: 10391333
references: J Thorac Cardiovasc Surg. 2008 Sep;136(3):641-8; discussion 948-9
references: 18805266
references: J Thorac Cardiovasc Surg. 2011 Sep;142(3):630-3
references: 21269650
references: J Thorac Cardiovasc Surg. 1995 Feb;109(2):259-68
references: 7853879
references: J Extra Corpor Technol. 2002 Jun;34(2):101-6
references: 12139117
references: J Card Surg. 1994 Sep;9(5):525-37
references: 7994095
references: J Cardiothorac Vasc Anesth. 2006 Feb;20(1):3-7
references: 16458205
references: Ann Thorac Surg. 2007 Feb;83(2):S796-8; discussion S824-31
references: 17257929
references: Circulation. 2004 Sep 14;110(11 Suppl 1):II250-5
references: 15364871
references: J Thorac Cardiovasc Surg. 1991 Jul;102(1):85-93; discussion 93-4
references: 2072732
references: J Cardiovasc Surg (Torino). 1995 Feb;36(1):31-7
references: 7721923
references: Ann Thorac Surg. 2010 May;89(5):1448-57
references: 20417760
references: J Thorac Cardiovasc Surg. 2011 Apr;141(4):948-52
references: 20674940
references: Ann Thorac Surg. 2007 Sep;84(3):759-66; discussion 766-7
references: 17720372
references: J Card Surg. 2008 Sep-Oct;23(5):480-7
references: 18462340
references: J Cereb Blood Flow Metab. 2003 May;23(5):513-30
references: 12771566
references: Ann Thorac Surg. 2010 Jul;90(1):72-7
references: 20609751
references: Ann Thorac Surg. 2000 Jul;70(1):3-8; discussion 8-9
references: 10921673
references: J Thorac Cardiovasc Surg. 2012 May;143(5):1205-12
references: 22306226
references: Ann Thorac Surg. 2001 Jul;72(1):72-9
references: 11465234
references: Ann Thorac Surg. 2001 Jun;71(6):1905-12
references: 11426767
references: Cardiol Clin. 2010 May;28(2):389-401
references: 20452558
references: Ann Thorac Surg. 1994 May;57(5):1305-10
references: 8179405
references: Ann Thorac Cardiovasc Surg. 2003 Jun;9(3):174-9
references: 12875639
references: Front Neurol. 2011 Feb 03;2:4
references: 21331282
references: Ann Thorac Surg. 2009 Jan;87(1):117-23
references: 19101283
references: J Thorac Cardiovasc Surg. 1995 Apr;109(4):738-43
references: 7715222
references: Eur J Cardiothorac Surg. 2010 Jun;37(6):1332-6
references: 20444617
references: J Thorac Cardiovasc Surg. 2002 Dec;124(6):1080-6
references: 12447172
references: J Thorac Cardiovasc Surg. 1993 Jul;106(1):19-28; discussion 28-31
references: 8321002
references: J Card Surg. 1994 Sep;9(5):584-94; discussion 594-5
references: 7994100
references: Ann Thorac Surg. 2012 May;93(5):1502-8
references: 22480393
references: Cardiol Clin. 2010 May;28(2):381-7
references: 20452557
references: Gen Thorac Cardiovasc Surg. 2012 Mar;60(3):132-9
references: 22419180
references: Ann Thorac Surg. 2001 Nov;72(5):1774-82
references: 11722099
references: Semin Thorac Cardiovasc Surg. 2010 Winter;22(4):291-301
references: 21549269
references: Perfusion. 1999 Jul;14(4):247-56
references: 10456778
references: J Thorac Cardiovasc Surg. 2009 Nov;138(5):1081-9
references: 19758609
references: Circulation. 1989 Sep;80(3 Pt 1):I243-8
references: 2766533
references: Circ Res. 1964 Aug;15:SUPPL:201-4
references: 14206303
references: Ann Thorac Surg. 2012 Jul;94(1):90-5; discussion 95-6
references: 22607790
references: J Neurochem. 1975 Feb;24(2):311-6
references: 1113108
references: J Card Surg. 2009 Sep-Oct;24(5):486-9
references: 19549051