Deep Hypothermic Circulatory Arrest with Retrograde Cerebral Perfusion: How Long is Safe?

This expert single-center series analyzes 1,429 ascending aorta and arch replacements performed between 1991 and 2020 with circulatory arrest at nadir temperatures of 14 to 20°C with retrograde cerebral perfusion, including 464 acute type A dissections. The authors report overall operative mortality of 8.9 percent and stroke rate of 8.4 percent. The incidence of stroke was less than 5 percent when retrograde perfusion lasted less than twenty minutes and 11.5 percent at sixty minutes, with a linear relationship. The authors recommend other adjuncts for cerebral protection if circulatory arrest is anticipated to be more than sixty minutes.