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The optimal cerebral protective method and extent of surgery have been long-standing controversies in acute type A aortic dissection surgery. Given that data from randomized trial are not available and future trials are also unrealistic, observational data based on large registry or meta-analyses may alternatively provide reliable and reasonable evidence. With regard to neuroprotective methods for arch repair, currently available observational data strongly suggest that there are no overt superiority among unilateral-antegrade cerebral perfusion, bilateral-antegrade cerebral perfusion, and retrograde cerebral perfusion, by which their availabilities are still open in real clinical practices depending on institutional preferences. When deciding the extent of arch repair in acute DeBakey type I aortic dissection, multiple factors should be considered altogether such as aortic anatomic characteristics as well as patient's risk profiles for optimizing early safety and late aortic longevity.<\/jats:p>","DOI":"10.1177\/02184923221083365","type":"journal-article","created":{"date-parts":[[2022,3,16]],"date-time":"2022-03-16T02:44:58Z","timestamp":1647398698000},"page":"32-36","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":3,"title":["Unsolved issues in acute type A aortic dissection"],"prefix":"10.1177","volume":"31","author":[{"given":"Sung Jun","family":"Park","sequence":"first","affiliation":[{"name":"Department of Thoracic and Cardiovascular Surgery, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, South 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