Aortic arch surgery is a complex and high-risk operation undertaken to correct aneurysms, dissections, and traumatic aortic injuries. Despite notable improvement in surgical technique, perioperative care, and neuroprotection, the risk of neurological complications remains a predominant cause of concern. Such complications, which include permanent and transient neurological deficits, spinal cord damage, intellectual dysfunction, and seizures, are caused by conditions like cerebral hypoperfusion, embolism, reperfusion injury, and systemic inflammatory responses. The review seeks to summarize available evidence to cover the incidence, risk factors, mechanisms, prevention, and management of neurological complications in aortic arch surgery. It also evaluates the effectiveness of preventative strategies such as selective antegrade cerebral perfusion, hypothermia, intraoperative monitoring, and new pharmacologic approaches (i.e., hypertonic saline dextran, thiopental) in reducing neurological risk. Despite advances, there are important gaps in the management of long-term complications, reflecting the need for ongoing innovation in surgical and perioperative care. This review is a summary to assist clinicians in decreasing adverse outcomes in this high-risk group of patients.
Keywords: Aortic arch surgery; Hemiarch surgery; Neurocognitive decline; Neurological complications; Stroke; Total arch replacement.
© 2025. The Author(s).