title: Total circulatory arrest for the replacement of the descending and thoracoabdominal aorta.
abstract: OBJECTIVE
  Hypothermic total circulatory arrest (TCA) in the resection and replacement of the thoracoabdominal and descending thoracic aorta is safe, will significantly decrease the incidence of postoperative renal failure, and should be preferentially performed over left heart bypass (LHB).
  
  
  METHODS
  Retrospective review case series.
  
  
  METHODS
  Large, private, urban teaching hospital.
  
  
  METHODS
  All adult patients with aortic disease that involved the distal aortic arch, the descending thoracic aorta, or the thoracoabdominal aorta who underwent resection and graft replacement of the diseased segment via LHB or TCA at our institution from 1989 to 2001 are included in this study. A total of 59 patients were evaluated: 10 had descending thoracic aneurysms, 20 had thoracoabdominal aneurysms, 22 had chronic type B dissections, 4 had acute type B dissections, and 3 had adult coarctations.
  
  
  METHODS
  In 1989 to 1994, LHB was primarily used; in 1994 to 2001, TCA was primarily used.
  
  
  METHODS
  Renal failure, 30-day operative mortality, paraplegia, and any other morbidities.
  
  
  RESULTS
  A significant decrease occurred in the incidence of postoperative renal failure from 15% (3/20) in patients who underwent LHB to 0% (0/39) in patients who underwent TCA (P = .04). Furthermore, a significant decrease occurred in the 30-day operative mortality, which decreased from 20% (4/20) in patients who underwent LHB to 5% (2/39) in patients who underwent TCA (P = .04). Postoperative paraplegia decreased from 5% (1/20) in patients who underwent LHB to 2.6% (1/39) in patients who underwent TCA (P > .99).
  
  
  CONCLUSIONS
  Our use of TCA in the resection and replacement of the diseased thoracoabdominal and descending thoracic aorta has produced excellent results. Our patients have experienced no postoperative renal failure and a low 30-day operative mortality. The use of TCA in this patient population is a viable option for surgeons comfortable with the technique.
authors.affiliation: Department of Surgery, Division of Cardiothoracic Surgery, Cedars-Sinai Medical Center, Los Angeles, Calif 90048, USA.
authors.forename: Harmik J
authors.initials: HJ
authors.lastname: Soukiasian
authors.forename: Sharo S
authors.initials: SS
authors.lastname: Raissi
authors.forename: Thomas
authors.initials: T
authors.lastname: Kleisli
authors.forename: Alan T
authors.initials: AT
authors.lastname: Lefor
authors.forename: Gregory P
authors.initials: GP
authors.lastname: Fontana
authors.forename: Lawrence S C
authors.initials: LS
authors.lastname: Czer
authors.forename: Alfredo
authors.initials: A
authors.lastname: Trento
mesh_terms: D000328:Adult; D000784:Aortic Dissection / Q000401:mortality / Q000601:surgery*; D001014:Aortic Aneurysm / Q000401:mortality / Q000601:surgery*; D001017:Aortic Coarctation / Q000401:mortality / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation; D016009:Chi-Square Distribution; D005260:Female; D006324:Heart Arrest, Induced; D006801:Humans; D008297:Male; D011183:Postoperative Complications; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome