Rc. King et al., HYPOTHERMIC CIRCULATORY ARREST DOES NOT INCREASE THE RISK OF ASCENDING THORACIC AORTIC-ANEURYSM RESECTION, Annals of surgery, 227(5), 1998, pp. 702-707
Objective The purpose of this study was to investigate the safety and
efficacy of a period of deep hypothermic circulatory arrest (DHCA) dur
ing elective replacement of the ascending thoracic aorta. Summary Back
ground Data DHCA has been implemented in ascending thoracic aortic ane
urysm resection whenever the anatomy or pathology of the aorta or arch
vessels prevents safe or adequate cross-clamping. Profound hypothermi
a and retrograde cerebral perfusion have been shown to be neurological
ly protective during ascending aortic replacement under circulatory ar
rest. Methods The authors conducted a retrospective analysis of 91 con
secutive patients who underwent repair of chronic ascending thoracic a
ortic aneurysms from 1986 to present. The authors hypothesized that pa
tients undergoing DHCA with or without retrograde cerebral perfusion d
uring aneurysm repair were at no greater operative risk than patients
who received aneurysm resection while on standard cardiopulmonary bypa
ss. Results There were no significant differences in hospital mortalit
y, stroke rate, or operative morbidity between patients repaired on DH
CA when compared to those repaired on cardiopulmonary bypass. Conclusi
ons 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 complicati
ons associated with cross-clamping a friable or atherosclerotic aorta.