THE USE OF PROFOUND HYPOTHERMIA AND CIRCULATORY ARREST IN OPERATIONS ON THE THORACIC AORTA

Objective: This retrospective study reviews the contemporary surgical outcome of our patients undergoing operations on thoracic aneurysms in deep hypothermic circulatory arrest. Methods: Between January 1989 an d February 1995, 279 patients were operated on in our institution on v arious portions of the aorta. In 143 patients (97 male, 46 female), de ep hypothermia and circulatory arrest were used as the standard operat ive technique. Patients age ranged from 16 to 83 years (mean 55). Fina l indication for operation was dissection Type A in 80 patients (61 ac ute, 19 chronic), dissection Type B in 21 patients (17 acute, 4 chroni c) and atherosclerotic aneurysms in 42 patients (11 acute, 31 chronic) . 16 patients were operated under preoperative unstable hemodynamic co nditions, 6 patients had been resuscitated preoperatively. Surgical te chnique included cardiopulmonary bypass with femoral artery cannulatio n. For added cerebral protection all patients received Cortisone and b arbiturates right before circulatory arrest (confirmed by O-EEG). The segment of the aorta containing the area with the aneurysm, was resect ed and replaced with a tubular albumin coated graft. Results: The 30-d ay mortality was 31.15% (19/61) in the acute and 23.52% (4/19) in the chronic type A dissection group, 35.29% (6/17) in the acute and 25% (1 /4) in the chronic type B group, 36.3% (4/11) in the acute and 22.58% (7/31) in the chronic atherosclerotic group. Causes of postoperative d eath in order of frequency were: multiorgan failure (n = 15), myocardi al failure (n = 13), bleeding (n = 3), sepsis (n = 4), myocardial infa rction (n = 3) and stroke (n = 2). Conclusion: Despite rather high mor tality rates in the acute aneurysm groups, the technique of profound h ypothermic circulatory arrest represents a relatively safe method for operations on the thoracic aorta. Copyright (C) 1997 Elsevier Science B.V.