HYPOTHERMIC CIRCULATORY ARREST DOES NOT INCREASE THE RISK OF ASCENDING THORACIC AORTIC-ANEURYSM RESECTION

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.