Aortic arch replacement with profound hypothermia and temporary circulatory arrest

Two cases of aortic arch aneurysm are reported. In each case, resection and replacement with a woven Dacron graft were performed with the patient in profound hypothermia and temporary circulatory arrest. Barbiturates and lidocaine provided additional cerebral protection. One patient died 27 days postoperatively of hepatic failure due to preexisting alcoholic liver cirrhosis. Clinical and autopsy studies showed intact neurological function and cerebral structures. The second patient had an uneventful postoperative course. The neurological examination, the skull computer tomogram and electroencephalogram disclosed no evidence of cerebral ischemic damage. Our findings suggest that by using barbiturates and lidocaine with profound hypothermia and temporary circulatory arrest, adequate cerebral protection for aortic arch replacement is provided.