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In aortic arch surgery is there any benefit in using antegrade cerebral perfusion or retrograde cerebral perfusion as an adjunct to hypothermic circulatory arrest?

^a Department of Cardiothoracic Surgery, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL, UK
^b Department of Cardiothoracic Surgery, Freeman Hospital, Freeman Road, Newcastle upon Tyne, UK
^c Department of Cardiothoracic Surgery, Wythenshawe Hospital, Southmoor Road, Manchester M23 9LT, UK

^* Corresponding author. Tel./fax: +44 780 154 8122. (E-mail: joeldunning{at}doctors.org.uk).

A best evidence topic in cardiothoracic surgery was written according to a structured protocol. The question addressed was whether patients having aortic arch surgery benefit from antegrade or retrograde cerebral perfusion in addition to hypothermic circulatory arrest to reduce neurological injury or mortality. Altogether 408 papers were found using the reported search, of which 16 presented the best evidence to answer the clinical question. The author, journal, date and country of publication, patient group studied, study type, relevant outcomes, results, and study weaknesses of these papers are tabulated. We conclude that antegrade cerebral perfusion is superior as an adjunct to hypothermic circulatory arrest when compared to retrograde cerebral perfusion or hypothermic circulatory arrest alone, although clinical evidence for this from prospective clinical trials is weak.