Development of aortic arch surgery in Bologna and reflections on current strategy of cerebral protection

Complications after open arch repair much decreased over time thanks to better methods of organ and cerebral protection. The crossroads was the introduction of antegrade cerebral perfusion as a method of cerebral protection. Other intraoperative techniques also contributed to facilitate arch reconstruction, such as performing circulatory arrest at higher core temperature, using hybrid grafts or endografts, and monitoring cerebral functions during the procedure. As part of this exciting process, we go back in Bologna in the early 1970s to relive some of these fundamental steps on aortic arch surgery. Today a large number of issues on cerebral protection remain for which we have incomplete responses. Probably, a super specialized approach and endovascular techniques will continue to improve the quality of care of patients with different arch pathologies.