Aortic arch and hemiarch surgery necessitate the temporary interruption
of blood perfusion to the brain. Despite its complexity, hemiarch and
ascending aortic surgery can be performed via a minimally invasive
approach. Due to the higher risk of neurological injury during
circulatory arrest, several techniques were developed to further protect
the brain during this surgery. We searched the Embase, Medline, and
Cochrane databases and identified articles reporting outcomes of
antegrade and retrograde cerebral perfusion strategies. Herein, we
outline surgical approaches, intra-operative technical considerations,
and clinical outcomes of hemiarch and ascending aortic surgery.