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Deep hypothermic circulatory arrest alone is a viable approach in many instances, but the need for a prolonged duration of circulatory arrest and increasing case complexity have led to the utilization of adjunctive cerebral perfusion strategies. In this review, we discuss the efficacy of deep hypothermic circulatory arrest and its limitations, the role of retrograde cerebral perfusion and unilateral and bilateral antegrade cerebral perfusion, and the trend towards goal-directed perfusion strategies, all emphasizing the pressing need for randomized clinical trials to better define the optimal strategy.<\/jats:p>","DOI":"10.1177\/0218492320929212","type":"journal-article","created":{"date-parts":[[2020,5,22]],"date-time":"2020-05-22T00:23:47Z","timestamp":1590107027000},"page":"605-611","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":5,"title":["Goal-directed cerebral perfusion in aortic arch surgery: scientific leap or hype?"],"prefix":"10.1177","volume":"29","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4847-5649","authenticated-orcid":false,"given":"Xiaoying","family":"Lou","sequence":"first","affiliation":[{"name":"Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5486-6238","authenticated-orcid":false,"given":"Edward P","family":"Chen","sequence":"additional","affiliation":[{"name":"Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2020,5,21]]},"reference":[{"key":"bibr1-0218492320929212","doi-asserted-by":"publisher","DOI":"10.1177\/1089253216672850"},{"key":"bibr2-0218492320929212","doi-asserted-by":"publisher","DOI":"10.1007\/s11748-016-0699-z"},{"key":"bibr3-0218492320929212","doi-asserted-by":"publisher","DOI":"10.1016\/S0022-5223(19)39653-9"},{"key":"bibr4-0218492320929212","doi-asserted-by":"publisher","DOI":"10.1093\/bja\/aep335"},{"key":"bibr5-0218492320929212","doi-asserted-by":"publisher","DOI":"10.1007\/s11748-017-0879-5"},{"key":"bibr6-0218492320929212","doi-asserted-by":"publisher","DOI":"10.1016\/S0022-5223(19)33737-7"},{"key":"bibr7-0218492320929212","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtcvs.2017.08.015"},{"key":"bibr8-0218492320929212","doi-asserted-by":"publisher","DOI":"10.1093\/ejcts\/ezx133"},{"key":"bibr9-0218492320929212","doi-asserted-by":"publisher","DOI":"10.1016\/j.athoracsur.2019.08.043"},{"key":"bibr10-0218492320929212","doi-asserted-by":"publisher","DOI":"10.1067\/mtc.2001.115244"},{"key":"bibr11-0218492320929212","first-page":"61","volume":"43","author":"Ueda T","year":"1990","journal-title":"Kyobu Geka"},{"key":"bibr12-0218492320929212","doi-asserted-by":"publisher","DOI":"10.1016\/j.athoracsur.2017.07.018"},{"key":"bibr13-0218492320929212","doi-asserted-by":"publisher","DOI":"10.1016\/S1010-7940(02)00380-9"},{"key":"bibr14-0218492320929212","doi-asserted-by":"publisher","DOI":"10.1586\/14779072.5.6.1147"},{"key":"bibr15-0218492320929212","first-page":"163","volume":"2","author":"Yan TD","year":"2013","journal-title":"Ann Cardiothorac Surg"},{"key":"bibr16-0218492320929212","doi-asserted-by":"publisher","DOI":"10.1016\/j.athoracsur.2013.06.085"},{"key":"bibr17-0218492320929212","doi-asserted-by":"publisher","DOI":"10.1016\/j.athoracsur.2015.05.032"},{"key":"bibr18-0218492320929212","doi-asserted-by":"publisher","DOI":"10.1016\/j.athoracsur.2017.02.066"},{"key":"bibr19-0218492320929212","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtcvs.2009.07.045"},{"key":"bibr20-0218492320929212","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtcvs.2012.07.063"},{"key":"bibr21-0218492320929212","doi-asserted-by":"publisher","DOI":"10.1016\/j.athoracsur.2016.10.024"},{"key":"bibr22-0218492320929212","unstructured":"Urbanski PP, Thamm T, Bougioukakis P, et\u00a0al. Efficacy of unilateral cerebral perfusion for brain protection in aortic arch surgery.\n                      J Thorac Cardiovasc Surg\n                      2019 Feb 21. pii: S0022-5223(19)30473-8."},{"key":"bibr23-0218492320929212","doi-asserted-by":"publisher","DOI":"10.1016\/j.athoracsur.2010.03.118"},{"key":"bibr24-0218492320929212","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtcvs.2017.02.053"},{"key":"bibr25-0218492320929212","doi-asserted-by":"publisher","DOI":"10.1510\/icvts.2008.184184"},{"key":"bibr26-0218492320929212","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtcvs.2012.10.029"},{"key":"bibr27-0218492320929212","doi-asserted-by":"publisher","DOI":"10.1016\/j.athoracsur.2015.01.070"},{"key":"bibr28-0218492320929212","doi-asserted-by":"publisher","DOI":"10.1510\/icvts.2008.184184"},{"key":"bibr29-0218492320929212","doi-asserted-by":"publisher","DOI":"10.1177\/1089253216672854"},{"key":"bibr30-0218492320929212","unstructured":"Hameed I, Rahouma M, Khan FM, et\u00a0al. Cerebral protection strategies in aortic arch surgery: a network meta-analysis.\n                      J Thorac Cardiovasc Surg\n                      2019 Feb 21. pii: S0022-5223(19)30483-0."},{"key":"bibr31-0218492320929212","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijsu.2019.01.009"},{"key":"bibr32-0218492320929212","doi-asserted-by":"publisher","DOI":"10.1016\/j.athoracsur.2015.06.029"},{"key":"bibr33-0218492320929212","unstructured":"Ghoreishi M, Sundt TM, Cameron DE, et\u00a0al. Factors associated with acute stroke after type A aortic dissection repair: an analysis of the Society of Thoracic Surgeons National Adult Cardiac Surgery Database.\n                      J Thorac Cardiovasc Surg\n                      2019 Jun 18. pii: S0022-5223(19)31213-9."},{"key":"bibr34-0218492320929212","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtcvs.2015.07.054"},{"key":"bibr35-0218492320929212","doi-asserted-by":"publisher","DOI":"10.1016\/j.athoracsur.2018.10.008"},{"key":"bibr36-0218492320929212","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtcvs.2011.10.094"}],"container-title":["Asian Cardiovascular and Thoracic Annals"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/0218492320929212","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/0218492320929212","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/0218492320929212","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T17:55:30Z","timestamp":1777398930000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/0218492320929212"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,5,21]]},"references-count":36,"journal-issue":{"issue":"7","published-print":{"date-parts":[[2021,9]]}},"alternative-id":["10.1177\/0218492320929212"],"URL":"https:\/\/doi.org\/10.1177\/0218492320929212","relation":{},"ISSN":["0218-4923","1816-5370"],"issn-type":[{"value":"0218-4923","type":"print"},{"value":"1816-5370","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,5,21]]}}}