CPB AND AORTIC SURGERY The state of the Art (From a Theoritical to a Practical Approach)

Background
Despite recent improvements in prevention, medical treatment [1]and endovascular aortic repair , invasive surgery associated with cardiopulmonary bypass (CPB) remains the best option of treatment for some patients.
The aim of this study is to make a review of the specific CPB protocols associated with these invasive surgical approaches, based on our clinical experience and according to the recent literature.
Up to now, these protocols are not supported by evidence based in medicine (EBM) [2] or in perfusion (EBP).
Discrepancies can be observed regarding target temperature , selective cerebral protection , CPB circuit concept and arterial cannulation sites .
Variables guidelines are suggested concerning regional flow , transfusion requirements [3], coagulation monitoring blood gas management[4] as for cerebral and CPB monitoring tools.
Conclusions
In the absence of EBM and EBP in the aortic surgery field, the short and long terms clinical outcomes of the patients elected to invasive surgery for aortic diseases must guide and substantiate our choices of techniques and of CPB protocols.