title: Current trends in cannulation and neuroprotection during surgery of the aortic arch in Europe.
abstract: OBJECTIVE
  To conduct a survey across European cardiac centres to evaluate the methods used for cerebral protection during aortic surgery involving the aortic arch.
  
  
  METHODS
  All European centres were contacted and surgeons were requested to fill out a short, comprehensive questionnaire on an internet-based platform. One-third of more than 400 contacted centres completed the survey correctly.
  
  
  RESULTS
  The most preferred site for arterial cannulation is the subclavian-axillary, both in acute and chronic presentation. The femoral artery is still frequently used in the acute condition, while the ascending aorta is a frequent second choice in the case of chronic presentation. Bilateral antegrade brain perfusion is chosen by the majority of centres (2/3 of cases), while retrograde perfusion or circulatory arrest is very seldom used and almost exclusively in acute clinical presentation. The same pumping system of the cardio pulmonary bypass is most of the time used for selective cerebral perfusion, and the perfusate temperature is usually maintained between 22 and 26°C. One-third of the centres use lower temperatures. Perfusate flow and pressure are fairly consistent among centres in the range of 10-15 ml/kg and 60 mmHg, respectively. In 60% of cases, barbiturates are added for cerebral protection, while visceral perfusion still receives little attention. Regarding cerebral monitoring, there is a general tendency to use near-infrared spectroscopy associated with bilateral radial pressure measurement.
  
  
  CONCLUSIONS
  These data represent a snapshot of the strategies used for cerebral protection during major aortic surgery in current practice, and may serve as a reference for standardization and refinement of different approaches.
authors.affiliation: Department of Cardiac Surgery, European Hospital, Rome, Italy depauli@tin.it.
authors.forename: Ruggero
authors.initials: R
authors.lastname: De Paulis
authors.affiliation: Department of Cardiac Surgery, University Hospital, Zurich, Switzerland.
authors.forename: Martin
authors.initials: M
authors.lastname: Czerny
authors.affiliation: Department of Cardiac Surgery, European Hospital, Rome, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Weltert
authors.affiliation: Department of Cardiac Surgery, University Hospital, Philadelphia, PA, USA.
authors.forename: Joseph
authors.initials: J
authors.lastname: Bavaria
authors.affiliation: Department of Cardiac Surgery, Heart Center, Leipzig, Germany.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Borger
authors.affiliation: Department of Cardiac Surgery, University Hospital, Berne, Switzerland.
authors.forename: Thierry P
authors.initials: TP
authors.lastname: Carrel
authors.affiliation: Department of Cardiac Surgery, Heart Center, Leipzig, Germany.
authors.forename: Christain D
authors.initials: CD
authors.lastname: Etz
authors.affiliation: Department of Cardiac Surgery, Medical University, Innsbuck, Austria.
authors.forename: Michael
authors.initials: M
authors.lastname: Grimm
authors.affiliation: Department of Cardiac Surgery, Castle Hill Hospital, Hull, UK.
authors.forename: Mahmoud
authors.initials: M
authors.lastname: Loubani
authors.affiliation: Department of Cardiac Surgery, Policlinico Sant' Orsola, Bologna, Italy.
authors.forename: Davide
authors.initials: D
authors.lastname: Pacini
authors.affiliation: Department of Cardiac Surgery, Skane University Hospital, Malmö, Sweden.
authors.forename: Timothy
authors.initials: T
authors.lastname: Resch
authors.affiliation: Department of Cardiac Surgery, Herz und Gefaess Klinik, Bad Neustadt, Germany.
authors.forename: Paul P
authors.initials: PP
authors.lastname: Urbanski
authors.affiliation: Department of Vascular Surgery, Academic Hospital Hubertus, Berlin, Germany.
authors.forename: Ernst
authors.initials: E
authors.lastname: Weigang
mesh_terms: D000368:Aged; D001013:Aorta, Thoracic / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000601:surgery*; D002404:Catheterization / Q000639:trends*; D005060:Europe / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D007430:Intraoperative Care / Q000379:methods*; D000066829:Neuroprotection; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control*; D011795:Surveys and Questionnaires
keywords: Aortic arch; Neuroprotection