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Should circulatory arrest with deep hypothermia be revised in aortic arch surgery?
C Deville1, X Roques, G Fernandez
1Hôpital Cardiologique du Haut-Leveque, Pessac-Bordeaux, France.
Summary
Deep hypothermia with circulatory arrest is effective for aortic arch surgery, particularly for aortic dissection. Mild hypothermia may be suitable for shorter procedures, balancing risks and benefits.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Vascular Surgery
Background:
- Aortic arch surgery presents significant challenges due to the complexity of the aorta and its branches.
- Deep hypothermia with circulatory arrest has been utilized to manage these complex repairs.
Purpose of the Study:
- To evaluate the efficacy and outcomes of deep hypothermia with circulatory arrest in patients undergoing aortic arch surgery.
- To compare outcomes between aortic dissection and aneurysm repair using this technique.
Main Methods:
- Retrospective analysis of 41 patients undergoing aortic arch surgery between January 1982 and May 1987.
- Procedures involved circulatory arrest with deep hypothermia (mean rectal temperature 18.4°C).
- Total or partial aortic arch replacement was performed in most cases.
Main Results:
- Hospital mortality was 22% (9 patients), with higher rates in aortic dissection (26.6%) than aneurysms (9%).
- Neurological complications occurred in 3 patients.
- Mean circulatory arrest time was 41 minutes.
Conclusions:
- Deep hypothermia with circulatory arrest is a preferred method for aortic arch surgery, especially for dissections.
- Mild hypothermia may be considered for shorter procedures (<30 min).
- Alternative strategies like moderate hypothermia with brachiocephalic perfusion are suggested for specific patient groups.