Research Progress of Cerebral Protection Strategy in Aortic Arch Surgery for Adults——Moderate Hypothermic Circulatory Arrest with Selective Antegrade Cerebral Perfusion_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

LIFang ,  WANGRu-rong

Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu 610041, P. R. China;

Corresponding author：

WANGRu-rong, Email: 5769500@qq.com

Keywords：

Circulatory arrest; Induced by moderate hypothermia; Selective antegrade cerebral perfusion; Brain protection; Aortic arch; Surgery

DOI：

10.7507/1007-4848.20160175

Video：

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Increasing evidences show that a gradual trend away from deep hypothermia toward moderate hypothermic circulatory arrest, which has been proved to be safe and effective in clinic. By summarizing and analyzing the research progress and applying status of the moderate hypothermia circulatory arrest with selective antegrade cerebral perfusion, the article aims at promoting the application of this tenique as a cerebral protection strategy in aortic arch surgery for adults in China.

Citation： LIFang, WANGRu-rong. Research Progress of Cerebral Protection Strategy in Aortic Arch Surgery for Adults——Moderate Hypothermic Circulatory Arrest with Selective Antegrade Cerebral Perfusion. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2016, 23(7): 732-737. doi: 10.7507/1007-4848.20160175 Copy

1.	Griepp RB, Stinson EB, Hollingsworth JF, et al. Prosthetic replace-ment of the aortic arch. J Thorac Cardiovasc Surg, 1975, 70(3):1051-1063.
2.	Yan TD, Bannon PG, Bavaria J, et al. Consensus on hypothermia in aortic arch surgery. Ann Cardiothorac Surg, 2013, 2(2):163-168.
3.	Livesay JJ, Cooley DA, Reul GJ, et al. Resection of aortic arch aneur-ysms:a comparison of hypothermic techniques in 60 patients. Ann Thorac Surg, 1983, 36(1):19-28.
4.	Kamiya H, Hagl C, Kropivnitskaya I, et al. The safety of moderate hypothermic lower body circulatory arrest with selective cerebral perfusion:a propensity score analysis. J Thorac Cardiovasc Surg, 2007, 133(2):501-509.
5.	Cooper WA, Duarte IG, Thourani VH, et al. Hypothermic circula-tory arrest causes multisystem vascular endothelial dysfunction and apoptosis. Ann Thorac Surg, 2000, 69(3):696-702.
6.	Egerton N, Egerton WS, Kay JH. Neurologic Changes Following Profound Hypothermia. Ann Surg, 1963, 157(3):366-374.
7.	Wilde JT. Hematological consequences of profound hypothermic circulatory arrest and aortic dissection. J Card Surg, 1997, 12:201-206.
8.	Gutsche JT, Feinman J, Silvay G, et al. Practice variations in the conduct of hypothermic circulatory arrest for adult aortic arch repair:Focus on an emerging European paradigm. Heart Lung Vessel, 2014, 6(2 Suppl):43-51.
9.	Wass CT, Lanier WL, Hofer RE, et al. Temperature changes of 1℃ alter functional neurologic outcome and histopathology in a canine model of a complete cerevral ischemia. Anesthesiology, 1995, 83:325-335.
10.	Kawai N, Okauchi M, Morisaki K, et al. Effects of delayed intrais-chemic and postischemic hypothermia on a focal model of transient cerebral ischemia in rats. Stroke, 2014, 6(1):1982-1989.
11.	Kirklin JW, Barratt-Boyes BG. Hypothermia, circulatory attest, and cardiopulmonary bypass. In Kirklin JW, Barratt-Boyes BG (eds):Cardiac surgery, 2nd ed. New York, Churchill Livingstone, 1993, 5(6):61-127.
12.	Moon MR, Sundt TM. Aortic arch aneurysms. Coron Artery Dis, 2002, 13(7):85-92.
13.	Svensson LG, Crawford ES, Hess KR, et al. Deep hypothermia with circulatory arrest. Determinants of stroke and early mortality in 656 patients. J Thorac Cardiovasc Surg, 1993, 106(1):19-28.
14.	Zierer A, Moon MR, Melby SJ, et al. Impact of perfusion strategy on neurologic recovery in acute type A aortic dissection. Ann Thorac Surg, 2007, 83:2122-2128.
15.	Mazzelli M, Marotta M, Lin HM, et al. Duration of deep hypothermia during aortic surgery and the risk of perioperative blood transfu-sion. Ann Card Anaesth, 2012, 15(6):266-273.
16.	Williams JB, Phillips-Bute B, Bhattacharya SD, et al. Predictors of massive transfusion with thoracic aortic procedures involving deep hypothermic circulatory arrest. J Thorac Cardiovasc Surg, 2011, 141(4):1283-1288.
17.	Ehrlich MP, McCullough JN, Zhang N, et al. Effect of hypothermia on cerebral blood flow and metabolism in the pig. Ann Thorac Surg, 2002, 73:191-197.
18.	Usui A, Oohara K, Murakami F, et al. Body temperature influences regional tissue blood flow during retrograde cerebral perfusion. J Thorac Cardiovasc Surg, 1997, 114(1):440-447.
19.	Nussmeier NA, Cheng W, Marino M, et al. Temperature during cardiopulmonary bypass:The discrepancies between monitored sites. Anesth Analg, 2006, 103(6):1373-1379.
20.	Akata T, Setoguchi H, Shirozu K, et al. Reliability of temperatures measured at atandard monitoring sites as an index of brain tempera-ture during deep hypothermic cardiopulmonary bypass conducted for thoracic aortic reconstruction. J Thorac Cardiovasc Surg, 2007, 133(6):1559-1565.
21.	Amir G, Ramamoorthy C, Riemer RK, et al. Deep brain hyperthermia while rewarming from hypothermic circulatory arrest. J Card Surg, 2009, 2(5):606-610.
22.	Camboni D, Phillip A, Schebesch KM, et al. Accuracy of core temperature measurement in deep hypothermic circulatory arrest. Interact Cardiothorac Thorac Surg, 2008, 7(5):922-924.
23.	Gega A, Rizzo JA, Michele HJ, et al. Straight Deep Hypothermic Arrest:Experience in 394 Patients Supports Its Effectiveness as a Sole Means of Brain Preservation. Ann Thorac Surg, 2007, 84(3):759-767.
24.	Okita Y, Minatoya K, Tagusari O, et al. Prospective comparative study of brain protection in total aortic arch replacement:deep hypothermic circulatory arrest with retrograde cerebral perfusion or selective antegrade cerebral perfusion. Ann Thorac Surg, 2001, 72(1):72-79.
25.	Svensson LG, Blackstone EH, Rajeswaran J, et al. Does the arterial cannulation site for circulatory arrest influence stroke risk? Ann Thorac Surg, 2004, 78(4):1274-1284.
26.	Hagl C, Ergin MA, Galla JD, et al. Neurologic outcome after ascending aorta-aortic arch operations:effect of brain protection technique in high-risk patients. J Thorac Cardiovasc Surg, 2001, 121:1107-1121.
27.	Bavaria JE, Pochettino A, Brinster DR, et al. New paradigms and improved results for the surgical treatment of acute type A dissection. Ann Surg, 2001, 234:336-342.
28.	Coselli JS, Lemaire SA. Experience with retrograde cerebral perfu-sion during proximal aortic surgery in 290 patients. J Card Surg, 1997, 12(3):322-325.
29.	Estrera AL, Miller CC 3rd, Lee TY, et al. Ascending and Transverse Aortic Arch Repair:The Impact of Retrograde Cerebral Perfusion. Circulation, 2008, 118(2 Suppl):S160-166.
30.	Reich DL, Uysal S, Ergin MA, et al. Retrograde cerebral perfusion as a method of neuroprotection during thoracic aortic surgery. Ann Thorac Surg, 2001, 72(1):1774-1782.
31.	Griepp RB, Bergin MA. Aneurysms of the aortic arch In Edmunds LH Jr. Cardiac Surg Adult, 1997, 3(6):1197-1226.
32.	Tian DH, Wan B, Bannon PG, et al. A meta-analysis of deep hypothermic circulatory arrest versus moderate hypothermic circulatory arrest with selective antegrade cerebral perfusion. Ann Cardiothorac Surg, 2013, 2(2):148-158.
33.	Leshnower B, Kilgo P, Chen E, et al. Total arch replacement using moderate hypothermic circulatory arrest and unilateral selective antegrade cerebral perfusion. J Thorac Cardiovasc Surg, 2014, 147(5):1488-1492.
34.	Numata S, Tsutsumi Y, Monta O, et al. Acute type A aortic dissec-tion repair with mild-to-moderate hypothermic circulatory arres-tand selective cerebral perfusion. J Cardiovasc Surg(Torino), 2015, 56(4):525-530.
35.	Okita Y. Total arch replacement using antegrade cerebral perfusion for distal aortic arch aneurysm. Ann Cardiothorac Surg, 2013, 2(3):367-368.
36.	Ruggero DP, Martin C, Luca W, et al. Current trends in cannulation and neuroprotection during surgery of the aortic arch in Europe. Eur J Thorac Cardiovasc Surg, 2015, 47(5):917-923.
37.	Banbury MK, Cosgrove DM 3rd. Arterial cannulation of the inno-minate artery. Ann Thorac Surg, 2000, 69(3):957.
38.	Huang FJ, Wu Q, Ren CW, et al. Cannulation of the innominate artery with a side graft in arch surgery. Ann Thorac Surg, 2010, 89 (3):800-803.
39.	Ourania P, Andrea G, Alexandra T, et al. Innominate artery cannula-tion for proximal aortic surgery:outcomes and neurological events in 263 patients. Eur J Thorac Cardiovasc Surg, 2015, 47(6):1-6.
40.	Augoustides JG, Desai ND, Szeto WY, et al. Innominate artery cannulation:The Toronto technique for antegrade cerebral perfu-sion in aortic arch reconstruction-a clinical trial opportunity for the International Aortic Arch Surgery Study Group. J Thorac Cardiovasc Surg, 2014, 148(6):2924-2926.
41.	Vinay G, Dickson J, Latter DA, et al. Direct innominate artery cannulation for selective antegrade cerebral perfusion during deep hypothermic circulatory arrest in aortic surgery. J Thorac Cardio-vasc Surg, 2014, 148(6):2920-2924.
42.	Merkkola P, Tulla H, Ronkainen A, et al. Incomplete circle of Willis and right axillary artery perfusion. Ann Thorac Surg, 2006, 82(1):74-79.
43.	Urbanski PP, Lenos A, Blume JC, et al. Does anatomical comple-teness of the circle of Willis correlate with sufficient cross-perfusion during unilateral cerebral perfusion? Eur J Cardiothorac Surg, 2008, 33(3):402-408.
44.	Macchi C, Catini C, Federico C, et al. Magnetic resonance angiogra-phic evaluation of circulus arteriosus cerebri (circle of Willis):a morphologic study in 100 human healthy subjects. Ital J Anat Embryol, 1996, 101(2):115-123.
45.	Krabbe-Hartkamp MJ, van der Grond J, de Leeuw FE, et al. Circle of Willis:morphologic variation on three dimensional time-of-flight MR angiograms. Radiology, 1998, 207(1):103-111.
46.	Angeloni E, Benedetto U, Takkenberg JJ, et al. Unilateral versus bilateral antegrade cerebral protection during circulatory arrest in aortic surgery:a meta-analysis of 5100 patients. J Thorac Cardiovasc Surg, 2014, 147(1):60-67.
47.	Qing M, Vazquez-Jimenez JF, Klosterhalfen B, et al. Influence of temperature during cardiopulmonary bypass on leukocyte activation, cytokine balance, and post-operative organ damage. Shook, 2001,15(5):372-377.
48.	Hiraoka A,Chikazawa G, Totsugawa T, et al. Acute kidney injury after total aortic arch repair with moderate hypothermic circulatory arrest. J Card Surg, 2014, 29(2):218-224.
49.	Di Bartolomeo R, Eusanio MD, Pacini D, et al. Antegrade selective cerebral perfusion during surgery of the thoracic aorta:risk analysis. Eur J Cardiothoracic Surg, 2001, 19(2):765-770.
50.	Etz CD, Luehr M, Kari FA, et al. Selective cerebral perfusion at 28 8C is the spinal cord safe? Eur J Cardiothorac Surg, 2009, 36(6):946-955.
51.	Minatoya K, Ogino H, Matsuda H, et al. Evolving selective cerebral perfusion for aortic arch replacement:high flow rate with moderate hypothermic circulatory arrest. Ann Thorac Surg, 2008, 86(6):1827-1831.
52.	Pacini A, Leone A, Di Marco L, et al. Antegrade selective cerebral perfusion in thoracic aorta surgery:safety of moderate hypothermia. Eur J Cardiothorac Surg, 2007, 31(4):618-622.
53.	Kamiya H, Hagl C, Kropivnitskaya I, et al. The safety of moderate hypothermic lower body circulatory arrest with selective cerebral perfusion:a propensity score analysis. J Thorac Cardiovasc Surg, 2007, 133(2):501-509.

1. Griepp RB, Stinson EB, Hollingsworth JF, et al. Prosthetic replace-ment of the aortic arch. J Thorac Cardiovasc Surg, 1975, 70(3):1051-1063.
2. Yan TD, Bannon PG, Bavaria J, et al. Consensus on hypothermia in aortic arch surgery. Ann Cardiothorac Surg, 2013, 2(2):163-168.
3. Livesay JJ, Cooley DA, Reul GJ, et al. Resection of aortic arch aneur-ysms:a comparison of hypothermic techniques in 60 patients. Ann Thorac Surg, 1983, 36(1):19-28.
4. Kamiya H, Hagl C, Kropivnitskaya I, et al. The safety of moderate hypothermic lower body circulatory arrest with selective cerebral perfusion:a propensity score analysis. J Thorac Cardiovasc Surg, 2007, 133(2):501-509.
5. Cooper WA, Duarte IG, Thourani VH, et al. Hypothermic circula-tory arrest causes multisystem vascular endothelial dysfunction and apoptosis. Ann Thorac Surg, 2000, 69(3):696-702.
6. Egerton N, Egerton WS, Kay JH. Neurologic Changes Following Profound Hypothermia. Ann Surg, 1963, 157(3):366-374.
7. Wilde JT. Hematological consequences of profound hypothermic circulatory arrest and aortic dissection. J Card Surg, 1997, 12:201-206.
8. Gutsche JT, Feinman J, Silvay G, et al. Practice variations in the conduct of hypothermic circulatory arrest for adult aortic arch repair:Focus on an emerging European paradigm. Heart Lung Vessel, 2014, 6(2 Suppl):43-51.
9. Wass CT, Lanier WL, Hofer RE, et al. Temperature changes of 1℃ alter functional neurologic outcome and histopathology in a canine model of a complete cerevral ischemia. Anesthesiology, 1995, 83:325-335.
10. Kawai N, Okauchi M, Morisaki K, et al. Effects of delayed intrais-chemic and postischemic hypothermia on a focal model of transient cerebral ischemia in rats. Stroke, 2014, 6(1):1982-1989.
11. Kirklin JW, Barratt-Boyes BG. Hypothermia, circulatory attest, and cardiopulmonary bypass. In Kirklin JW, Barratt-Boyes BG (eds):Cardiac surgery, 2nd ed. New York, Churchill Livingstone, 1993, 5(6):61-127.
12. Moon MR, Sundt TM. Aortic arch aneurysms. Coron Artery Dis, 2002, 13(7):85-92.
13. Svensson LG, Crawford ES, Hess KR, et al. Deep hypothermia with circulatory arrest. Determinants of stroke and early mortality in 656 patients. J Thorac Cardiovasc Surg, 1993, 106(1):19-28.
14. Zierer A, Moon MR, Melby SJ, et al. Impact of perfusion strategy on neurologic recovery in acute type A aortic dissection. Ann Thorac Surg, 2007, 83:2122-2128.
15. Mazzelli M, Marotta M, Lin HM, et al. Duration of deep hypothermia during aortic surgery and the risk of perioperative blood transfu-sion. Ann Card Anaesth, 2012, 15(6):266-273.
16. Williams JB, Phillips-Bute B, Bhattacharya SD, et al. Predictors of massive transfusion with thoracic aortic procedures involving deep hypothermic circulatory arrest. J Thorac Cardiovasc Surg, 2011, 141(4):1283-1288.
17. Ehrlich MP, McCullough JN, Zhang N, et al. Effect of hypothermia on cerebral blood flow and metabolism in the pig. Ann Thorac Surg, 2002, 73:191-197.
18. Usui A, Oohara K, Murakami F, et al. Body temperature influences regional tissue blood flow during retrograde cerebral perfusion. J Thorac Cardiovasc Surg, 1997, 114(1):440-447.
19. Nussmeier NA, Cheng W, Marino M, et al. Temperature during cardiopulmonary bypass:The discrepancies between monitored sites. Anesth Analg, 2006, 103(6):1373-1379.
20. Akata T, Setoguchi H, Shirozu K, et al. Reliability of temperatures measured at atandard monitoring sites as an index of brain tempera-ture during deep hypothermic cardiopulmonary bypass conducted for thoracic aortic reconstruction. J Thorac Cardiovasc Surg, 2007, 133(6):1559-1565.
21. Amir G, Ramamoorthy C, Riemer RK, et al. Deep brain hyperthermia while rewarming from hypothermic circulatory arrest. J Card Surg, 2009, 2(5):606-610.
22. Camboni D, Phillip A, Schebesch KM, et al. Accuracy of core temperature measurement in deep hypothermic circulatory arrest. Interact Cardiothorac Thorac Surg, 2008, 7(5):922-924.
23. Gega A, Rizzo JA, Michele HJ, et al. Straight Deep Hypothermic Arrest:Experience in 394 Patients Supports Its Effectiveness as a Sole Means of Brain Preservation. Ann Thorac Surg, 2007, 84(3):759-767.
24. Okita Y, Minatoya K, Tagusari O, et al. Prospective comparative study of brain protection in total aortic arch replacement:deep hypothermic circulatory arrest with retrograde cerebral perfusion or selective antegrade cerebral perfusion. Ann Thorac Surg, 2001, 72(1):72-79.
25. Svensson LG, Blackstone EH, Rajeswaran J, et al. Does the arterial cannulation site for circulatory arrest influence stroke risk? Ann Thorac Surg, 2004, 78(4):1274-1284.
26. Hagl C, Ergin MA, Galla JD, et al. Neurologic outcome after ascending aorta-aortic arch operations:effect of brain protection technique in high-risk patients. J Thorac Cardiovasc Surg, 2001, 121:1107-1121.
27. Bavaria JE, Pochettino A, Brinster DR, et al. New paradigms and improved results for the surgical treatment of acute type A dissection. Ann Surg, 2001, 234:336-342.
28. Coselli JS, Lemaire SA. Experience with retrograde cerebral perfu-sion during proximal aortic surgery in 290 patients. J Card Surg, 1997, 12(3):322-325.
29. Estrera AL, Miller CC 3rd, Lee TY, et al. Ascending and Transverse Aortic Arch Repair:The Impact of Retrograde Cerebral Perfusion. Circulation, 2008, 118(2 Suppl):S160-166.
30. Reich DL, Uysal S, Ergin MA, et al. Retrograde cerebral perfusion as a method of neuroprotection during thoracic aortic surgery. Ann Thorac Surg, 2001, 72(1):1774-1782.
31. Griepp RB, Bergin MA. Aneurysms of the aortic arch In Edmunds LH Jr. Cardiac Surg Adult, 1997, 3(6):1197-1226.
32. Tian DH, Wan B, Bannon PG, et al. A meta-analysis of deep hypothermic circulatory arrest versus moderate hypothermic circulatory arrest with selective antegrade cerebral perfusion. Ann Cardiothorac Surg, 2013, 2(2):148-158.
33. Leshnower B, Kilgo P, Chen E, et al. Total arch replacement using moderate hypothermic circulatory arrest and unilateral selective antegrade cerebral perfusion. J Thorac Cardiovasc Surg, 2014, 147(5):1488-1492.
34. Numata S, Tsutsumi Y, Monta O, et al. Acute type A aortic dissec-tion repair with mild-to-moderate hypothermic circulatory arres-tand selective cerebral perfusion. J Cardiovasc Surg(Torino), 2015, 56(4):525-530.
35. Okita Y. Total arch replacement using antegrade cerebral perfusion for distal aortic arch aneurysm. Ann Cardiothorac Surg, 2013, 2(3):367-368.
36. Ruggero DP, Martin C, Luca W, et al. Current trends in cannulation and neuroprotection during surgery of the aortic arch in Europe. Eur J Thorac Cardiovasc Surg, 2015, 47(5):917-923.
37. Banbury MK, Cosgrove DM 3rd. Arterial cannulation of the inno-minate artery. Ann Thorac Surg, 2000, 69(3):957.
38. Huang FJ, Wu Q, Ren CW, et al. Cannulation of the innominate artery with a side graft in arch surgery. Ann Thorac Surg, 2010, 89 (3):800-803.
39. Ourania P, Andrea G, Alexandra T, et al. Innominate artery cannula-tion for proximal aortic surgery:outcomes and neurological events in 263 patients. Eur J Thorac Cardiovasc Surg, 2015, 47(6):1-6.
40. Augoustides JG, Desai ND, Szeto WY, et al. Innominate artery cannulation:The Toronto technique for antegrade cerebral perfu-sion in aortic arch reconstruction-a clinical trial opportunity for the International Aortic Arch Surgery Study Group. J Thorac Cardiovasc Surg, 2014, 148(6):2924-2926.
41. Vinay G, Dickson J, Latter DA, et al. Direct innominate artery cannulation for selective antegrade cerebral perfusion during deep hypothermic circulatory arrest in aortic surgery. J Thorac Cardio-vasc Surg, 2014, 148(6):2920-2924.
42. Merkkola P, Tulla H, Ronkainen A, et al. Incomplete circle of Willis and right axillary artery perfusion. Ann Thorac Surg, 2006, 82(1):74-79.
43. Urbanski PP, Lenos A, Blume JC, et al. Does anatomical comple-teness of the circle of Willis correlate with sufficient cross-perfusion during unilateral cerebral perfusion? Eur J Cardiothorac Surg, 2008, 33(3):402-408.
44. Macchi C, Catini C, Federico C, et al. Magnetic resonance angiogra-phic evaluation of circulus arteriosus cerebri (circle of Willis):a morphologic study in 100 human healthy subjects. Ital J Anat Embryol, 1996, 101(2):115-123.
45. Krabbe-Hartkamp MJ, van der Grond J, de Leeuw FE, et al. Circle of Willis:morphologic variation on three dimensional time-of-flight MR angiograms. Radiology, 1998, 207(1):103-111.
46. Angeloni E, Benedetto U, Takkenberg JJ, et al. Unilateral versus bilateral antegrade cerebral protection during circulatory arrest in aortic surgery:a meta-analysis of 5100 patients. J Thorac Cardiovasc Surg, 2014, 147(1):60-67.
47. Qing M, Vazquez-Jimenez JF, Klosterhalfen B, et al. Influence of temperature during cardiopulmonary bypass on leukocyte activation, cytokine balance, and post-operative organ damage. Shook, 2001,15(5):372-377.
48. Hiraoka A,Chikazawa G, Totsugawa T, et al. Acute kidney injury after total aortic arch repair with moderate hypothermic circulatory arrest. J Card Surg, 2014, 29(2):218-224.
49. Di Bartolomeo R, Eusanio MD, Pacini D, et al. Antegrade selective cerebral perfusion during surgery of the thoracic aorta:risk analysis. Eur J Cardiothoracic Surg, 2001, 19(2):765-770.
50. Etz CD, Luehr M, Kari FA, et al. Selective cerebral perfusion at 28 8C is the spinal cord safe? Eur J Cardiothorac Surg, 2009, 36(6):946-955.
51. Minatoya K, Ogino H, Matsuda H, et al. Evolving selective cerebral perfusion for aortic arch replacement:high flow rate with moderate hypothermic circulatory arrest. Ann Thorac Surg, 2008, 86(6):1827-1831.
52. Pacini A, Leone A, Di Marco L, et al. Antegrade selective cerebral perfusion in thoracic aorta surgery:safety of moderate hypothermia. Eur J Cardiothorac Surg, 2007, 31(4):618-622.
53. Kamiya H, Hagl C, Kropivnitskaya I, et al. The safety of moderate hypothermic lower body circulatory arrest with selective cerebral perfusion:a propensity score analysis. J Thorac Cardiovasc Surg, 2007, 133(2):501-509.

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Research Progress of Cerebral Protection Strategy in Aortic Arch Surgery for Adults——Moderate Hypothermic Circulatory Arrest with Selective Antegrade Cerebral Perfusion

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