Resection of the aortic arch using deep hypothermia and temporary circulatory arrest

Resection of the aortic arch has been associated with prohibitive morbidity and mortality because of the technical magnitude of the operation. Six patients, including a 6-year-old boy, recently underwent resection of an aneurysm involving the aortic arch. Deep systemic hypothermia was instituted utilizing cardiopulmonary bypass. Resection of the aneurysm and replacement with a Dacron prosthesis were then performed during a period of total circulatory arrest. During this period the total blood volume of the patient was transferred to the extracorporeal circuit, thus producing a completely dry operating field. Five patients are alive and well although one suffered a transient neurologic deficit from air embolism. The sixth patient died from bleeding. This technique considerably simplifies a difficult operation by producing excellent exposure and eliminating the need for continuous cerebral perfusion. Our experience suggests that resection utilizing deep hypothermia and temporary circulatory arrest is the treatment of choice for patients with aneurysms of the aortic arch.