Temperature and perfusion management in acute type A aortic dissection Surgery in mild to moderate hypothermic circulatory arrest and antegrade cerebral perfusion

The surgical treatment of acute type A aortic dissection has undergone a continuous development in the last decades, particularly with respect to the management of perfusion and temperature. Neurological complications are the main cause of postoperative morbidity and mortality. The use of a heart-lung machine, deep hypothermic circulatory arrest, temporary interruption of cerebral perfusion or hypoperfusion of the brain and manipulation of the aorta can lead to neurological damage. Circulatory arrest in deep hypothermia enables interventions on the thoracic aorta, which can be necessary for the repair of an acute dissection; however, this has limitations: the time for the intervention is limited and even the deep hypothermia leads to damage. Experimental and clinical studies could show that the degree of hypothermia has an influence on the complication rate. There is even still disagreement over the benefits of retrograde brain perfusion. The concept of circulatory arrest with additional brain perfusion has proven to be a safe method, especially when the degree of hypothermia is adapted corresponding to the expected duration of circulatory arrest. This enables complex interventions on the aorta with low complication rates and is increasingly used as the standard procedure in the treatment of acute type A dissection.