• High-risk patients undergoing aortic root surgery.

• Patients with aortic root aneurysms complicated by aortic valve disease, Marfan syndrome, or acute type A aortic dissection.

Ascending aortic root replacement and reconstruction is primarily performed to treat major cardiovascular conditions such as aortic root aneurysms with concomitant aortic valve disease, Marfan syndrome, and acute type A aortic dissection. These procedures often require deep hypothermic circulatory arrest (DHCA), during which prolonged cerebral ischemia may result in severe neurological injury.

To enhance cerebral protection and improve surgical safety, our institution was the first in Taiwan to implement the Bilateral Selective Antegrade Cerebral Perfusion (BSACP) technique in aortic surgery. This approach enables stable and continuous cerebral blood flow to be maintained under moderate hypothermia during total circulatory arrest, effectively reducing the incidence of postoperative neurological complications. It has proven especially beneficial in high-risk procedures, particularly in emergency surgeries for acute type A aortic dissection.

• Since 2006, our institution has been the first in Taiwan to implement the Bilateral Selective Antegrade Cerebral Perfusion (BSACP) technique in aortic surgery using specialized cannulation strategies.

• The BSACP technique provides a stable and safe operative environment, allowing young cardiovascular surgeons to perform all critical steps with greater focus and confidence. Under structured guidance, this approach facilitates systematic learning and offers ideal conditions for clinical training and surgical skill transmission in the field of cardiovascular surgery.

From 2006 to 2024, our institution has performed a total of 145 aortic surgeries utilizing the Bilateral Selective Antegrade Cerebral Perfusion (BSACP) technique. 2. Among these, 28 were classified as high-risk cases involving ascending aortic root replacement.

• The incidence of permanent neurological deficits after surgery was 0.0%.

• The rate of deep sternal wound infection was 0.0%.

• The 30-day postoperative mortality rate was 3.6%.

• The overall survival rates at five and ten years were 88.8% and 70.7%, respectively, indicating favorable long-term outcomes.

• Postoperative outcome data were superior to most published domestic and international reports.

Patient satisfaction regarding both the surgical process and hospitalization remained consistently high, with mean scores of 93.7 and 92.8, respectively—both exceeding the predefined quality benchmark of 90.

A clinical case report was presented at the EuroPCR Congress held in Paris, France.

• The Bilateral Selective Antegrade Cerebral Perfusion (BSACP) technique, originally applied in ascending aortic root replacement surgeries, can also be extended to other complex aortic procedures such as total arch replacement. This technique significantly enhances surgical safety and long-term outcomes.

• This technique provides a safe and stable operative environment during aortic surgeries, enabling junior surgeons to gain hands-on experience under the guidance of senior physicians. Through structured training, they progressively develop the ability to independently perform high-risk cardiovascular procedures, becoming key personnel equipped with critical surgical skills. This contributes to the resilience and sustainable development of the healthcare system.