Impact of Antegrade Selective Cerebral Perfusion Flow Ranges on Clinical and Neurological Outcomes in Aortic Arch Surgery

Abstract Objectives To evaluate the association between selective antegrade cerebral perfusion (SACP) flow ranges and early clinical outcomes in a large cohort of patients undergoing aortic arch surgery. Methods We retrospectively analysed 492 adult patients who underwent aortic arch surgery with bilateral antegrade cerebral perfusion under moderate hypothermia between 2015 and 2024. Patients were stratified into low, intermediate, or high-indexed SACP pump flow groups according to measured intraoperative flow rates (mL/kg/minute). Primary outcomes included in-hospital mortality, permanent neurologic dysfunction, and transient neurological deficit. Results Overall, 80.3% of patients received antegrade selective cerebral perfusion flows within the intermediate range (10-15 mL/kg/minute). No statistically significant differences were observed among groups in terms of early mortality, permanent neurological dysfunction, or transient neurological deficit. When cerebral perfusion flow was analysed as a continuous variable, no linear association with adverse outcomes was identified (all P > .15). Importantly, intraoperative perfusion strategies were largely guided by clinical judgement, with flow adjustments tailored to individual patient characteristics and dynamic intraoperative factors, including extremes of body weight. Conclusions No significant association was observed between SACP flow ranges and clinical outcomes within the flow ranges and management strategy applied in this cohort. Nonetheless, maintaining SACP within an optimal range remains advisable. Individualized flow adjustments by the clinical team, based on patient-specific factors, likely contributed to the observed flow distribution and outcomes.