Which Method of Cerebral Protection Do You Prefer to Use for Aortic Arch Surgery?

Key Words

Aortic arch surgery - Cerebral protection techniques

Starting with the inaugural issue, we would like the AORTA journal to feature a special section, “Poll the Editorial Board,” in which readers ask questions and the journal provides a poll of answers from the Editorial Board. In this way, we hope to assess the thought and practice patterns of the Editorial Board.

The question for the first issue was:

Which method of cerebral protection do you favor during aortic arch surgery?

• Straight deep hypothermic circulatory arrest (DHCA)

• Selective antegrade cerebral perfusion

• Retrograde cerebral perfusion

• DHCA or cerebral perfusion, depending on case complexity

The poll was distributed among all current members of the Editorial Board, who were asked to submit their responses via an online survey tool. The list of Editorial Board members can be found at the AORTA journal website (http://aorta.scienceinternational.org). The members of the Editorial Board whose practices do not lie within the scope of this question were asked to disregard this poll. Here we present the results of this poll.

Results of the “Poll the Editorial Board”

Twenty-nine members of the Editorial Board submitted responses through our online survey tool. The results are presented in [Table 1] and in the pie chart in [Figure 1].

Table 1. Responses of the Editorial Board Members

Favored Cerebral Protection Technique	No. of votes	Percentage
Straight DHCA	5	17%
Selective antegrade cerebral perfusion	13	45%
Retrograde cerebral perfusion	2	7%
DHCA, or cerebral perfusion depending on case complexity	9	31%

DHCA indicates deep hypothermic circulatory arrest.

Figure 1. Pie chart diagram illustrating the responses of the Editorial Board members to the poll. DHCA indicates deep hypothermic circulatory arrest.

Comment

The majority of the respondents (45%) indicated their preference for selective antegrade cerebral perfusion. However, it is interesting to note that despite the highly popularized and publicized technique of selective antegrade cerebral perfusion, almost half of the respondents (48%) either still use straight DHCA as a stand-alone method for cerebral protection during most aortic arch operations (17%) or use it for some of the relatively simpler cases of arch interventions (31%). At the same time, retrograde cerebral perfusion is becoming increasingly less popular, with only 7% of respondents showing a preference for this technique.