Cerebral Protection Strategies in Aortic Arch Surgery—Past Developments, Current Evidence, and Future Innovation

Werner, Paul; Winter, Martin; Mahr, Stephané; Stelzmueller, Marie-Elisabeth; Zimpfer, Daniel; Ehrlich, Marek

doi:10.3390/bioengineering11080775

Open AccessPerspective

Cerebral Protection Strategies in Aortic Arch Surgery—Past Developments, Current Evidence, and Future Innovation

by

Paul Werner

^*,†

,

Martin Winter

^*,†,

Stephané Mahr

,

Marie-Elisabeth Stelzmueller

,

Daniel Zimpfer

and

Marek Ehrlich

Department of Cardiac Surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria

^*

Authors to whom correspondence should be addressed.

^†

These authors contributed equally to this work.

Bioengineering 2024, 11(8), 775; https://doi.org/10.3390/bioengineering11080775

Submission received: 22 May 2024 / Revised: 18 July 2024 / Accepted: 26 July 2024 / Published: 31 July 2024

(This article belongs to the Special Issue Individualized Cardiovascular Implants: Latest Devices, Techniques and Strategies)

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Abstract

Surgery of the aortic arch remains a complex procedure, with neurological events such as stroke remaining its most dreaded complications. Changes in surgical technique and the continuous innovation in neuroprotective strategies have led to a significant decrease in cerebral and spinal events. Different modes of cerebral perfusion, varying grades of hypothermia, and a number of pharmacological strategies all aim to reduce hypoxic and ischemic cerebral injury, yet there is no evidence indicating the clear superiority of one method over another. While surgical results continue to improve, novel hybrid and interventional techniques are just entering the stage and the question of optimal neuroprotection remains up to date. Within this perspective statement, we want to shed light on the current evidence and controversies of cerebral protection in aortic arch surgery, as well as what is on the horizon in this fast-evolving field. We further present our institutional approach as a large tertiary aortic reference center.

Keywords: aortic arch surgery; cerebral protection; cerebral perfusion; hypothermic circulatory arrest

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MDPI and ACS Style

Werner, P.; Winter, M.; Mahr, S.; Stelzmueller, M.-E.; Zimpfer, D.; Ehrlich, M. Cerebral Protection Strategies in Aortic Arch Surgery—Past Developments, Current Evidence, and Future Innovation. Bioengineering 2024, 11, 775. https://doi.org/10.3390/bioengineering11080775

AMA Style

Werner P, Winter M, Mahr S, Stelzmueller M-E, Zimpfer D, Ehrlich M. Cerebral Protection Strategies in Aortic Arch Surgery—Past Developments, Current Evidence, and Future Innovation. Bioengineering. 2024; 11(8):775. https://doi.org/10.3390/bioengineering11080775

Chicago/Turabian Style

Werner, Paul, Martin Winter, Stephané Mahr, Marie-Elisabeth Stelzmueller, Daniel Zimpfer, and Marek Ehrlich. 2024. "Cerebral Protection Strategies in Aortic Arch Surgery—Past Developments, Current Evidence, and Future Innovation" Bioengineering 11, no. 8: 775. https://doi.org/10.3390/bioengineering11080775

APA Style

Werner, P., Winter, M., Mahr, S., Stelzmueller, M.-E., Zimpfer, D., & Ehrlich, M. (2024). Cerebral Protection Strategies in Aortic Arch Surgery—Past Developments, Current Evidence, and Future Innovation. Bioengineering, 11(8), 775. https://doi.org/10.3390/bioengineering11080775

Note that from the first issue of 2016, this journal uses article numbers instead of page numbers. See further details here.

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Cerebral Protection Strategies in Aortic Arch Surgery—Past Developments, Current Evidence, and Future Innovation

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