title: Hypothermic Circulatory Arrest in Cardiac Transplantation.
abstract: OBJECTIVE
  Infrequently, hypothermic circulatory arrest (HCA) must be used during cardiac transplantation. Such cases may include concomitant aortic arch surgery, explantation of ventricular assist devices with outflow grafts or pseudoaneurysms closely abutting the sternum, and other scenarios for which dense mediastinal adhesions preclude exposure and anatomic dissection by conventional methods of adhesiolysis. Outcomes of heart transplantations performed with HCA have not been previously catalogued in the literature and are presented in the current case series.
  
  
  METHODS
  Between November 2012 and December 2014, 193 patients underwent heart transplantation at a single institution. Of these, 7 cases (3.6%) required implementation of HCA. Postoperative outcomes in these patients were analyzed using a prospectively maintained clinical database.
  
  
  RESULTS
  The HCA patients included 28% females, with mean age of 46 years, and 71% had nonischemic cardiomyopathies. The majority (N = 5, 71%) had prior ventricular assist device implantation, including 1 patient with a paracorporeal biventricular assist device. One of the remaining 2 patients had three previous surgeries for repair of tetralogy of Fallot, with a completely calcified right ventricular outflow tract and pulmonary arterial system. Mean HCA and cold ischemic times were 25 minutes (range, 9-34 minutes) and 285 minutes (range, 181-425 minutes), respectively. Mean postoperative length of stay was 31 days, and six of seven patients (86%) survived to hospital discharge. One patient expired as an outpatient 2 months following transplant. Rates of postoperative renal failure, respiratory failure, and stroke were 43%, 43%, and 29%, respectively.
  
  
  CONCLUSIONS
  On rare occasions, HCA must be instituted to safely conduct a complex heart transplantation procedure. Based on this small case series, these patients can be salvaged and discharged from the hospital, but may experience prolonged lengths of stay with moderate rates of other end-organ complications.
authors.affiliation: Department of Cardiac and Thoracic Surgery, Baylor University Medical Center, Dallas, Texas. Electronic address: brian.lima@baylorhealth.edu.
authors.forename: B
authors.initials: B
authors.lastname: Lima
authors.affiliation: Department of Cardiac and Thoracic Surgery, Baylor University Medical Center, Dallas, Texas.
authors.forename: T
authors.initials: T
authors.lastname: Chamogeorgakis
authors.affiliation: Department of Cardiac and Thoracic Surgery, Baylor University Medical Center, Dallas, Texas.
authors.forename: J C
authors.initials: JC
authors.lastname: MacHannaford
authors.affiliation: Department of Cardiac and Thoracic Surgery, Baylor University Medical Center, Dallas, Texas.
authors.forename: G V
authors.initials: GV
authors.lastname: Gonzalez-Stawinski
mesh_terms: D000328:Adult; D000368:Aged; D017541:Aneurysm, False / Q000209:etiology / Q000601:surgery; D001013:Aorta, Thoracic / Q000601:surgery; D050792:Circulatory Arrest, Deep Hypothermia Induced / Q000379:methods / Q000706:statistics & numerical data*; D050377:Cold Ischemia; D005260:Female; D016027:Heart Transplantation / Q000379:methods* / Q000706:statistics & numerical data; D006353:Heart-Assist Devices; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000601:surgery; D011446:Prospective Studies; D051437:Renal Insufficiency / Q000209:etiology; D012131:Respiratory Insufficiency / Q000209:etiology; D020521:Stroke / Q000453:epidemiology / Q000209:etiology; D000267:Tissue Adhesions / Q000601:surgery; D016896:Treatment Outcome; D055815:Young Adult