Recognising the significant variability in perfusion techniques across the UK, the latest webinar in the ongoing series focused on Perfusion in Aortic Dissection sought to explore these differences. The discussion centred on the results of a national scoping questionnaire designed to map current perfusion practices, identify gaps and lay the groundwork for standardised guidelines.
Understanding the Scope of the Survey
The national scoping questionnaire was developed to capture a comprehensive picture of perfusion strategies used in aortic dissection surgery. Distributed to perfusion departments across the UK, the survey featured 43 targeted questions covering six key areas:
- Institution and Team Structure – Examining whether centres have dedicated aortic teams or rely on general cardiac surgical teams.
- Heart-Lung Machine Configuration – Investigating the types of machines and circuits used in emergency dissection cases.
- Monitoring and Controls – Reviewing cerebral perfusion strategies, arterial pressure monitoring and perfusion flow control mechanisms.
- Blood Gas Management – Assessing acid-base balance strategies and haematocrit during surgery.
- Perfusion Parameters and Devices – Exploring variations in equipment, including arterial pumps, circuit configurations, and perfusion cannulas.
- Data Collection and Quality Control – Evaluating how centres record and audit perfusion practices to ensure consistency and quality improvement.
The survey results revealed notable differences between institutions, from the methods used for cerebral perfusion to how perfusionists are assigned to cases. Some centres operate with dedicated perfusion teams for aortic dissection, while others integrate cases into broader cardiac surgical teams. Equipment configurations also vary, with different preferences for arterial pumps, temperature management and monitoring tools.
Key Areas of Investigation
A major focus of the discussion was cerebral perfusion, a critical component of aortic dissection surgery. The survey explored which techniques centres use – such as selective antegrade cerebral perfusion versus retrograde cerebral perfusion – and how flow rates are monitored and controlled. Also, the use of specific perfusion cannulas, target flow rates, and the involvement of perfusionists versus surgeons in managing cerebral perfusion parameters were highlighted as areas lacking consistency.
Temperature management appeared as another key area of interest, given its role in neuroprotection and organ preservation during surgery. Centres differed in their approaches to cooling and rewarming strategies, with some prioritising bladder temperature while others used nasopharyngeal measurements. The range of targeted temperatures also varied, reflecting differing philosophies on optimal hypothermia and rewarming rates.
The discussion touched on the integration of electronic data capture and quality control mechanisms. While most centres now utilise digital systems, the extent and consistency of recorded perfusion parameters remain inconsistent, making it difficult to compare outcomes and optimise protocols across the UK.
Towards a National Minimum Standard
The findings from this survey highlight the need for a unified approach to perfusion in aortic dissection surgery. The next step in this initiative is to work towards establishing UK-wide minimum standards of practice in AD surgery, encompassing key areas such as:
- Optimising Monitoring Standards – Defining safe and effective diagnostic measurements.
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Perfusion clinical recommendations – Setting clear guidance on cerebral flow management, temperature control and other key parameters.
- Data collection and quality control – Developing national audit processes to track outcomes and refine protocols over time.
 To achieve this, a multidisciplinary working group will soon be formed, bringing together perfusionists, surgeons, anaesthetists and other key stakeholders. By collaborating across specialities, the goal is to create robust, evidence-based standards that improve patient outcomes and ensure consistency in care for all aortic dissection patients in the UK.
As discussions progress, all interested professionals are encouraged to contribute their expertise to this initiative, helping shape the future of perfusion practice in aortic dissection surgery.
Access the Webinar Series
Expand your expertise in aortic dissection perfusion by accessing the full recordings from the webinar series. Explore advanced perfusion techniques, safety protocols, decision-making strategies, and the latest innovations in complex aortic surgery.
