Is retrograde cerebral perfusion dead?

The concern about neurological injury following complex thor-acic aortic repair remains significant. Although dramatic improvements in surgical outcomes for aortic arch repair have been achieved, the incidence of stroke, temporary neurological deficit and fine neurocognitive changes still occur in as many as 10, 25 and 60 % of cases, respectively [1]. As an adjunct to pro-found hypothermic circulatory arrest (HCA), retrograde (RCP) and selective antegrade (SACP) cerebral perfusion have been adopted with excellent results. It appears, however, that over the last decade SACP has gained greater acceptance as the ‘cerebral adjunct of choice ’ for arch repair with only a few centres report-ing the use of RCP. The adoption of SACP arose from both animal and clinical data suggesting that RCP provided inad-equate cerebral perfusion and that neurological recovery was ul-timately improved with SACP [2]. These assertions, however