title: New frontiers in aortic therapy: focus on deep hypothermic circulatory arrest.
abstract: There is currently a paradigm shift in the conduct of adult aortic arch repair. Although deep hypothermic circulatory arrest has been the classic perfusion platform for adult aortic arch repair, recent developments have challenged this aortic arch paradigm. There has been a gradual clinical drift towards moderate, and even mild, hypothermic circulatory arrest combined with antegrade cerebral perfusion. This paradigm shift appears to be associated with equivalent clinical outcomes, and in certain settings, with improved outcomes. The advent of endovascular therapy has challenged even further the concept that circulatory arrest is required for adult aortic arch repair. These dramatic advances have resulted in the emergence of an international aortic arch surgery study group that aims to advance this dynamic field through consensus statements, meta-analysis, clinical database analysis, prospective registries, and randomized controlled trials.
authors.affiliation: Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
authors.forename: Jacob T
authors.initials: JT
authors.lastname: Gutsche
authors.affiliation: Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
authors.forename: Kamrouz
authors.initials: K
authors.lastname: Ghadimi
authors.affiliation: Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
authors.forename: Prakash A
authors.initials: PA
authors.lastname: Patel
authors.affiliation: Department of Anesthesiology, University of Florida College of Medicine, Gainesville, FL.
authors.forename: Albert R
authors.initials: AR
authors.lastname: Robinson
authors.affiliation: Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
authors.forename: Bernard J
authors.initials: BJ
authors.lastname: Lane
authors.affiliation: Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
authors.forename: Wilson Y
authors.initials: WY
authors.lastname: Szeto
authors.affiliation: Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA. Electronic address: yiandoc@hotmail.com.
authors.forename: John G T
authors.initials: JG
authors.lastname: Augoustides
mesh_terms: D017545:Aortic Aneurysm, Thoracic / Q000601:surgery*; D002560:Cerebrovascular Circulation / Q000502:physiology; D050792:Circulatory Arrest, Deep Hypothermia Induced / Q000639:trends*; D006801:Humans; D014656:Vascular Surgical Procedures
keywords: adult aortic arch repair; antegrade cerebral perfusion; cardiopulmonary bypass; clinical registry; deep hypothermic circulatory arrest; expert consensus; hybrid aortic arch repair; international aortic arch surgery study group; meta-analysis; mild hypothermia; moderate hypothermia; randomized controlled trial; retrograde cerebral perfusion; stroke; temporary neurologic dysfunction