Neurological complications post aortic arch surgery: a state of art review.
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Authors
Abdul-Rahman, Toufik
Mueller-Gomez, Jann Ludwig
Gaur, Aditya
Llama Luna, Miranda
Lisbona-Buzali, Marcos
Herrera-Calderón, Ranferi Eduardo
Thaalibi, Hala Ibrahim
Roy, Poulami
Mena-Guerrero, Tamara
Arshad, Mirza Ammar
Issue Date
2025-12-17
Type
Journal Article
Review
Review
Language
en
Keywords
Aortic arch surgery , Hemiarch surgery , Neurocognitive decline , Neurological complications , Stroke , Total arch replacement
Alternative Title
Abstract
Aortic arch surgery is a complex and high-risk operation undertaken to correct aneurysms, dissections, and traumatic aortic injuries. Despite notable improvement in surgical technique, perioperative care, and neuroprotection, the risk of neurological complications remains a predominant cause of concern. Such complications, which include permanent and transient neurological deficits, spinal cord damage, intellectual dysfunction, and seizures, are caused by conditions like cerebral hypoperfusion, embolism, reperfusion injury, and systemic inflammatory responses. The review seeks to summarize available evidence to cover the incidence, risk factors, mechanisms, prevention, and management of neurological complications in aortic arch surgery. It also evaluates the effectiveness of preventative strategies such as selective antegrade cerebral perfusion, hypothermia, intraoperative monitoring, and new pharmacologic approaches (i.e., hypertonic saline dextran, thiopental) in reducing neurological risk. Despite advances, there are important gaps in the management of long-term complications, reflecting the need for ongoing innovation in surgical and perioperative care. This review is a summary to assist clinicians in decreasing adverse outcomes in this high-risk group of patients.
Description
© The Author(s) 2025. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.
Citation
Abdul-Rahman, T. et al. (2025) 'Neurological complications post aortic arch surgery: a state of art review', Journal of Cardiothoracic Surgery 20(1) 459. Available At: https://doi.org/10.1186/s13019-025-03706-1
Publisher
Springer Nature Link
License
© 2025. The Author(s).
Journal
Journal of cardiothoracic surgery
Volume
20
Issue
1
PubMed ID
ISSN
1749-8090