How is the Brain Protected During Aortic Surgery?
Today Emmanuel Mbaka, The African Perfusionist teaches us 𝗛𝗼𝘄 𝗗𝗼 𝗪𝗲 𝗣𝗿𝗼𝘁𝗲𝗰𝘁 𝘁𝗵𝗲 𝗕𝗿𝗮𝗶𝗻 𝗗𝘂𝗿𝗶𝗻𝗴 𝗔𝗼𝗿𝘁𝗶𝗰 𝗦𝘂𝗿𝗴𝗲𝗿𝘆?
There is one organ we think about constantly during complex aortic surgery.
The brain.
Your brain depends on a continuous supply of oxygenated blood.
But there is something important about the anatomy: the arteries carrying blood toward the brain arise from the aortic arch.
Now imagine that the surgeon needs to repair that very part of the aorta.
A question immediately arises:
“What happens to blood flow to my brain while the surgeon is working there?”
This is where aortic surgery becomes particularly fascinating—and where careful teamwork is essential.
For some complex aortic arch operations, normal circulation may need to be temporarily altered. Brain protection therefore has to be planned before we reach that stage of the operation.
Cooling, which we discussed in Part 3, can be one part of that protection.
Depending on the operation and the surgical strategy, we may also use a technique called selective antegrade cerebral perfusion.
The name sounds complicated, but the idea is easier to understand:
We deliberately provide oxygenated blood toward the brain while the surgeon works on the aortic arch.
From the perfusionist’s side of the operating room, this is one of those moments when attention becomes incredibly focused.
I work closely with the surgeon and anesthesiology team while carefully managing and monitoring parameters such as blood flow, pressure, temperature, blood gases and oxygen delivery according to our cerebral-protection strategy.
We may also use near-infrared spectroscopy, commonly called NIRS.
You may have noticed small sensors placed on your forehead before surgery. These sensors provide the team with information about regional cerebral oxygenation and can help us follow changes during the operation.
So while the surgeon’s hands are repairing the aorta, another important question is continuously being considered by the team:
“Is the brain receiving the protection we expect?”
This is why complex aortic surgery is never the work of one person.
The surgeon is performing the repair.
The anesthesiology team is managing anesthesia and monitoring multiple physiologic systems.
The perfusionist is managing the heart-lung machine and supporting circulation according to the surgical and cerebral-protection strategy.
The nurses and the rest of the operating-room team are working alongside us.
Different responsibilities.
One patient.
One shared goal:
To complete the repair while protecting the person whose life is entrusted to us.
So if you have had aortic arch surgery and wondered:
“What was happening to my brain while I was asleep?”
Know that brain protection was not something we suddenly thought about during the operation.
It was part of the plan.
From before bypass.
Through cooling.
Through the repair.
And until circulation was restored.
That is another part of what happens behind the operating-room doors that patients may never get to see.
And that is the perfusionist’s perspective.
Educational note: Cerebral-protection techniques vary according to the operation, patient, surgical team and institution. This article provides general education and does not describe every possible strategy.
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