Hypothermic circulatory arrest does not increase the risk of ascending thoracic aortic aneurysm resection.
OBJECTIVE
The purpose of this study was to investigate the safety and efficacy of a period of deep hypothermic circulatory arrest (DHCA) during elective replacement of the ascending thoracic aorta.


BACKGROUND
DHCA has been implemented in ascending thoracic aortic aneurysm resection whenever the anatomy or pathology of the aorta or arch vessels prevents safe or adequate cross-clamping. Profound hypothermia and retrograde cerebral perfusion have been shown to be neurologically protective during ascending aortic replacement under circulatory arrest.


METHODS
The authors conducted a retrospective analysis of 91 consecutive patients who underwent repair of chronic ascending thoracic aortic aneurysms from 1986 to present. The authors hypothesized that patients undergoing DHCA with or without retrograde cerebral perfusion during aneurysm repair were at no greater operative risk than patients who received aneurysm resection while on standard cardiopulmonary bypass.


RESULTS
There were no significant differences in hospital mortality, stroke rate, or operative morbidity between patients repaired on DHCA when compared to those repaired on cardiopulmonary bypass.


CONCLUSIONS
DHCA with or without retrograde cerebral perfusion does not result in increased morbidity or mortality during the resection of ascending thoracic aortic aneurysms. In fact, this technique may prevent damage to the arch vessels in select cases and avoid the possible complications associated with cross-clamping a friable or atherosclerotic aorta.
King
R C
RC
Department of Surgery, University of Virginia Health Sciences Center, Charlottesville 22908, USA.
Kron
I L
IL
Kanithanon
R C
RC
Shockey
K S
KS
Spotnitz
W D
WD
Tribble
C G
CG
D000368:Aged; D017545:Aortic Aneurysm, Thoracic / Q000401:mortality / Q000601:surgery*; D017558:Elective Surgical Procedures; D005260:Female; D006324:Heart Arrest, Induced; D017052:Hospital Mortality; D006801:Humans; D007036:Hypothermia, Induced; D008297:Male; D008875:Middle Aged; D012086:Reoperation; D012189:Retrospective Studies; D012306:Risk