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Updated: May 22, 2026
Establishment of Deep Hypothermic Circulatory Arrest in Rats
Published on: December 16, 2022
Open repair of chronic aortic dissections using deep hypothermia and circulatory arrest
Joel S Corvera1, John W Fehrenbacher
1Indiana University Health Cardiovascular Surgeons, Indianapolis, Indiana 46202, USA. jcorvera@iuhealth.org
Insights
Open repair of chronic thoracic or thoracoabdominal aortic dissection (ChAD) using deep hypothermia and circulatory arrest (DHCA) demonstrates low operative risks and excellent long-term survival. This study highlights the durability of open repair for ChAD, contrasting with unproven endovascular methods.
Area of Science:
- Cardiovascular Surgery
- Vascular Surgery
- Thoracic Surgery
Background:
- Chronic thoracic or thoracoabdominal aortic dissection (ChAD) repair is increasingly performed using endografts, but long-term outcomes remain uncertain.
- Open repair using deep hypothermia and circulatory arrest (DHCA) offers an alternative, necessitating evaluation of its early and late results.
Purpose of the Study:
- To assess the early and late outcomes of open surgical repair for chronic thoracic or thoracoabdominal aortic dissection (ChAD).
- To compare the efficacy and safety of open repair with DHCA against emerging endovascular techniques for ChAD.
Main Methods:
- A retrospective analysis of 93 patients who underwent open repair of ChAD using DHCA between January 1995 and December 2009.
- Procedures involved aortic replacement, with or without bypass of visceral/renal arteries or supraaortic branches, under deep hypothermia and circulatory arrest.
Main Results:
- Operative mortality was low at 2.2%, with minimal rates of paralysis (1.1%) and stroke (1.1%).
- Long-term survival rates at 1, 3, 5, and 10 years were 93%, 90%, 79%, and 61%, respectively.
- Reintervention rates were low, addressing graft infection (2.2%), pseudoaneurysm (2.2%), and distal aneurysm growth (4.4%).
Conclusions:
- Open repair of ChAD utilizing DHCA is associated with low operative morbidity and mortality.
- This approach provides excellent long-term survival and a low reintervention rate.
- Current evidence does not support the short- or long-term efficacy of endovascular repair for ChAD.
Background:
There has been great enthusiasm for thoracic endograft repair of chronic thoracic or thoracoabdominal aortic dissection (ChAD) given the low operative morbidity and mortality. However long-term results are unknown and early reintervention is common. This study examines the early and late results of open repair of ChAD using deep hypothermia and circulatory arrest (DHCA).
Methods:
From January 1995 to December 2009, 343 patients had open repair of descending thoracic or thoracoabdominal aneurysms using DHCA. Of these individuals, 93 patients had open repair of ChAD with DHCA. All patients undergoing elective procedures underwent preoperative cardiac catheterization. Lumbar drains were not placed preoperatively. Visceral or renal artery bypass was performed in 20% of patients. Supraaortic branches were bypassed in 14% of patients.
Results:
Mean age was 60 ± 14 years. Men composed 77% of the cohort. Aortic replacement encompassed the descending aorta in 29% of patients, type I thoracoabdominal repair was performed in 25% of patients, type II thoracoabdominal repair was performed in 40% of patients, and arch replacement was performed in 24% of patients. Operative mortality was 2.2%, renal failure requiring dialysis was 0%, paralysis occurred in 1.1% of patients, stroke occurred in 1.1% of patients, prolonged intubation was needed in 9.7% of patients, and tracheostomy was needed in 2.2% of patients. Postoperative length of stay was 10.5 ± 7.6 days. One-, 3-, 5-, and 10-year survival rates were 93%, 90%, 79%, and 61%, respectively. Reintervention was necessary in 2.2% of patients for graft infection, in 2.2% of patients for anastomotic pseudoaneurysm, and in 4.4% of patients for growth of a distal aortic aneurysm.
Conclusions:
Open repair of ChAD with DHCA has low operative morbidity and mortality. Long-term survival is very good with low rates of reintervention. Endovascular repair of ChAD does not have proven short- or long-term efficacy.
