Beating heart arch replacement without circulatory arrest: a standardized surgical strategy.

Deep hypothermic circulatory arrest, antegrade brain perfusion and cardioplegic arrest are commonly used organ protection techniques during aortic arch surgery. We present our surgical strategy for beating heart aortic arch surgery without circulatory arrest. Cardiopulmonary bypass access is achieved through the right and/or left axillary artery for continuous cerebral perfusion under neurophysiological monitoring and femoral cannulation through an EndoReturn cannula while using a Coda balloon catheter for visceral perfusion. Systemic cooling is applied between 28 and 32 °C.