Neurologic Protection

Prevention of stroke remains one of the central challenges in aortic surgery, and our practice takes numerous precautions to minimize the risk of neurologic complications. Strokes in complex aortic surgery may be the result of emboli (usually tiny particles of calcium or debris) which travel to the brain and cause damage. Some of our strategies for neurologic protection are below.

Axillary Cannulation
As many patients with aortic disease have widespread atherosclerotic disease throughout the aorta, we routinely avoid using the ascending aorta itself for access for cardiopulmonary bypass. Our standard approach for aortic surgery uses the left axillary artery for connection to the cardiopulmonary bypass circuit, which has been associated with decreased embolic associated neurologic complications.

Deep Hypothermic Circulatory Arrest (DHCA)
For many complex aortic operations, it is necessary to completely stop all blood flow within the body for a short period of time to gain safe access to certain areas of the aorta. This is accomplished by cooling the patient to very low temperatures using the cardiopulmonary bypass circuit as well as cooling blankets and packing ice around the patient's head. With appropriate cooling and other adjunctive measures, blood flow can be stopped safely with full neurologic recovery.

Selective Cerebral Perfusion
For aortic arch replacements, as the procedure is performed, flow can be reinstituted via the trifurcation graft once completed. This allows for earlier re-establishment of blood flow to the brain, a shorter period of circulatory arrest and less chance of neurologic deficit.

More about aortic arch aneurysm:  Causes   Indications   Surgical Treatment   Neurologic Protection

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