Deep hypothermic circulatory arrest in adults undergoing aortic surgery: local experience

The aim of our study was to evaluate the efficacy and safety of deep hypothermic circulatory arrest (DHCA) as a method of cerebral protection during aortic surgery.

We carried out a retrospective review of 59 consecutive patients (48 men, 11 women) undergoing elective or emergency aortic surgery requiring DHCA from January 1999 to April 2002 in 2 tertiary care hospitals. Data regarding demographics, clinical characteristics, operation type, duration of circulatory arrest, nasopharyngeal temperatures, use of retrograde cerebral perfusion and central nervous system (CNS) morbidity and perioperative mortality were collected and analysed.

There were 47 (79.7 %) operations for aortic dissections and 12 (20.3 %) for aortic aneurysms. The mean duration of circulatory arrest was 42 +/- 23 minutes. The lowest nasopharyngeal temperature at the time of arrest was 16.5 degrees +/- 1.9 degrees C. Eight (13.6 %) patients had a new irreversible neurologic deficit postoperatively. These patients had a mean circulatory arrest time of 50 +/- 28 minutes. Temporary neurologic dysfunction occurred in 8 (13.6 %) patients. Intra-hospital mortality was 22 %. The mean circulatory arrest time for patients who died was 54 +/- 24 minutes.

DHCA is a simple and effective method of CNS protection in aortic surgery with satisfactory outcomes. With increased surgical and anaesthetic experience, as well as selective use of adjuncts of cerebral protection, reductions in mortality and neurological morbidity will likely be achieved in the future.