Hypothermic circulatory arrest for aortic dissection with cryoglobulinemia

Area of Science:

• Cardiovascular Surgery
• Immunology
• Vascular Medicine

Background:

• Cryoglobulinemia is a rare autoimmune disorder triggered by cold exposure.
• Stanford type A acute aortic dissection is a life-threatening cardiovascular emergency.
• Management of patients with autoimmune diseases undergoing major surgery presents unique challenges.

Observation:

• A 64-year-old male patient with active cryoglobulinemia presented with Stanford type A acute aortic dissection.
• The patient received immunosuppressive therapy and plasma exchange (PE), resulting in negative cryoglobulin (CG) qualitative analysis.
• He underwent emergency ascending aorta replacement using cardiopulmonary bypass (CPB) with deep hypothermia and selective cerebral perfusion.

Findings:

• The surgical procedure involved prolonged cardiopulmonary bypass (255 min), aortic cross-clamp (153 min), and selective cerebral perfusion (56 min) at a minimal nasopharyngeal temperature of 17.3°C.
• The patient experienced no significant perioperative complications.
• This case demonstrates the feasibility of complex cardiac surgery in patients with cryoglobulinemia under specific conditions.

Implications:

• Appropriate management, including plasma exchange and achieving negative cryoglobulin levels, may enable safe surgical intervention for cryoglobulinemia patients with severe conditions.
• Deep hypothermia circulatory arrest can be safely employed in these high-risk patients.
• This case supports a multidisciplinary approach for managing complex surgical cases in patients with autoimmune disorders.