Abstract Due to the technical necessity to enter the aortic arch during
surgery for aortic dissection type A, the brain must be protected
optimally to avoid damage to our most precious organ. The different
options are reviewed starting with deep hypothermic circulatory arrest
which was the first technique described to protect the brain. Its major
advantage is the bloodless surgical field and its simplicity but the
time constraints limit its application in complex and extended repairs.
Therefore antegrade cerebral perfusion has actually become much more
popular because this technique allows for much longer arrest periods in
which the brain is perfused in a physiological manner reducing the
cerebral complications after surgery. Pros and cons of the existing
techniques are discussed.