Moderate Hypothermie in der Aortenbogenchirurgie: eine Gefahr für das Rückenmark?

Surgery of the transverse arch still is one of the most challenging procedures in cardiovascular surgery associated with significant (neurologic) morbidity and mortality. In the past, selective cerebral perfusion (SCP) in combination with deep hypothermia gained widespread acceptance as the standard approach in aortic arch surgery. In recent years, SCP in combination with moderate hypothermia of up to 28°C, more recently even up to 32°C was introduced to avoid deep hypothermia-associated complications. However, this new perfusion strategy may lead to prolonged distal ischemia during mild hypothermia (or even normothermia), and therefore, bares an underestimated risk for the viscerals and the spinal cord. This article illustrates the development of various neuroprotective perfusion strategies utilized in modern aortic surgery focussing in particular on the core temperature managment during the currently most widely adopted technique ?C antegrade SCP ?C and discusses the pros and cons of the current trend towards normothermic core temperature management by critically reviewing the contemporary experimental and clinical literature.