ArticleFrontiers in physiology2026
Multimodal neuromonitoring-guided cerebral protection and early neurocognitive outcomes after aortic arch surgery.
Article in Frontiers in physiology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Open aortic arch surgery exposes patients to hypothermic circulatory arrest, selective antegrade cerebral perfusion, rewarming, and arch-vessel manipulation. Postoperative delirium and early cognitive decline remain clinically important complications. Because single-modality cerebral oximetry cannot fully capture perioperative cerebral physiological burden, this study evaluated whether a multimodal neuromonitoring-guided cerebral-protection protocol was associated with lower cerebral physiological burden and improved early neurocognitive outcomes after aortic arch surgery. Methods: This retrospective single-center cohort study screened consecutive adult patients who underwent open aortic arch surgery from January 1, 2021 to April 30, 2026. Patients treated from January 1, 2021 to December 31, 2023 formed the conventional cerebral-protection cohort, and patients treated from January 1, 2024 to April 30, 2026 formed the multimodal-guided cohort. The guided protocol used bilateral near-infrared spectroscopy, processed electroencephalography, transcranial Doppler, and cerebral oximetry index-derived autoregulation monitoring to trigger correction of perfusion pressure, selective antegrade cerebral perfusion flow, cannula position, PaCO Results: The final cohort included 186 patients, with 92 in the conventional cohort and 94 in the multimodal-guided cohort. The guided cohort had lower absolute rSO Conclusions: In adult aortic arch surgery, implementation of a multimodal neuromonitoring-guided cerebral-protection protocol was associated with lower intraoperative cerebral physiological burden, lower postoperative delirium risk, and less MoCA-defined 30-day cognitive decline. These findings support the use of complementary neuromonitoring signals within a structured correction pathway rather than reliance on a single cerebral oxygenation threshold.
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