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Abstract
Deep hypothermic circulatory arrest with or without RCP and ACP are currently being used as methods of brain protection. Technical simplicity and avoidance of aorta and arch vessels manipulation as well as a bloodless operative field make DHCA an attractive method of brain protection especially during ascending aorta and hemi arch replacement when a short period of circulatory arrest is anticipated. However, hypothermia-associated coagulopathy, and pulmonary, renal and microembolic complications are important disadvantages associated with DHCA . ACP provides several advantages, the circulatory arrest time can safely be extended up to 90 minutes allowing more complex aortic repair to be performed and moderate (nasopharyngeal,25°C) instead of profound hypothermia can be used with reduced coagulative and systemic complications. Criticism against ACP includes technical complexity, reduced surgical visibility and manipulation of the aortic arch and arch vessels especially in case of acute dissections or severely atherosclerotic aortic arch aneurysms. In the current study, we compared DHCA and ACP in terms of neurological outcome in a group of patients (40 patients) undergoing hemi arch or total arch replacement. In our series, the ACP group patients had a more extended aortic tissue replacement. Nevertheless, hospital mortality and neurological outcome were comparable in the two groups.