AORTIC-VALVE OPERATIONS UNDER DEEP HYPOTHERMIC CIRCULATORY ARREST FORTHE PORCELAIN AORTA - NO-TOUCH TECHNIQUE

Background. Aortic valve replacement or repair becomes a high-risk pro cedure in patients in whom the ascending aorta cannot be clamped eithe r because of extensive calcification and risk of cerebral embolus or b ecause of extensive adhesions precluding safe dissection and clamping. Methods. We report the results of aortic valve replacement or repair with deep hypothermic circulatory arrest in 3 patients. Techniques to improve results include routine use of epiaortic and transesophageal e chocardiography, avoidance of manipulation of the ascending aorta unti l the circulation is arrested, avoidance of antegrade cardioplegia, ro utine use of retrograde cardioplegia and retrograde cerebral perfusion , when feasible, and minimal aortotomy (just enough to excise and repl ace or repair the valve). Results. Operations were accomplished in app roximately 1 hour each with minimal manipulation of the aorta, thus mi nimizing aortic trauma and subsequent risk of cerebral embolus. Each p atient had an unremarkable recovery without neurologic complications. Conclusions. Aortic valve replacement or repair using the ''no-touch'' technique and deep hypothermic circulatory arrest is the preferred me thod when dealing with the porcelain or unclampable aorta. (C) 1998 by The Society of Thoracic Surgeons.