The most significant challenge in surgical repair of the aortic arch (transverse thoracic aorta) is to protect the brain from ischemic injury. During the portion of the procedure when the brachiocephalic vessels are at tached to a graft, there is an obligatory interruption in the normal path of circulation to the brain. Various strategies are used to overcome the potential for brain injury during discontinuity between the aorta and the cerebral circulation. These include deep hypothermic circulatory arrest, retrograde cerebral perfusion, and selective anterograde cerebral perfusion. Pharmaco logic adjuncts to these procedures are also used to further enhance brain protection. This review ad dresses the relative merits of these techniques as means of cerebral protection.
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