Closed chest hypothermic circulatory arrest for complex intracranial aneurysms

Background. Recent advances in techniques of cardiopulmonary bypass permitt ed hypothermic circulatory arrest (HCA) using groin cannulation with the ch est closed (CC-HCA) and without direct access to the heart. Herein we descr ibe our experience with this technique for complex intracranial aneurysms. Methods. Between 1992 and 1999, 16 patients (4 men and 12 women) with a mea n age of 52 years (range 32 to 61 years) with complex intracranial aneurysm s underwent resection or clipping of their aneurysms at our institution usi ng the technique of CC-HCA and groin cannulation. Groin access was obtained with 16F to 19F arterial and 18F to 20F venous cannulas placing the tips a t the aortoiliac and atriocaval junctions, respectively. Patients were cool ed to a nasopharyngeal temperature of 16 degreesC. Results. Mean circulatory arrest time was 32 minutes. No patient required c onversion to standard sternotomy ind central Cannulation. There were no int raoperative deaths. The 30-day hospital mortality was 2 of 16 patients (12% ). Of the 14 surviving patients (88%), 1 developed bilateral third nerve pa lsy and another left hemiparesis that improved on follow-up. Both were disc harged to an extended care facility and continued to do well at home after discharge. Two patients developed deep venous thrombosis postoperatively an d required anticoagulation. All patients continued to do well at a mean fol low-up of 42 months. Conclusions. The less invasive technique of CC-HCA through groin cannulatio n avoids complications associated with a sternotomy, is safe and is associa ted with little morbidity, reduced operative time, and early hospital disch arge and rehabilitation.