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Published on: October 27, 2020
The Role of Deep Hypothermia in Cardiac Surgery
Radosław Gocoł1, Damian Hudziak1, Jarosław Bis1,2
1Upper-Silesian Heart Center, Department of Cardiac Surgery, 40-635 Katowice, Poland.
Insights
Deep hypothermia (DH) protects organs during cardiac surgery, enabling circulatory arrest. However, safe use requires strict temperature monitoring and limits on circulatory arrest duration to prevent neurological damage.
Area of Science:
- Cardiovascular Surgery
- Physiology
Background:
- Hypothermia, a core body temperature below 35°C, has four stages: mild, moderate, deep, and profound.
- Deep hypothermia (DH) is crucial for organ protection in cardiac surgery, facilitating safe circulatory arrest.
- DH is employed in adult cardiac surgery for aortic arch repairs, pulmonary embolism treatment, and acute type-A aortic dissections.
Purpose of the Study:
- To outline the applications of deep hypothermia in adult and congenital cardiac surgery.
- To emphasize the critical safety parameters and limitations associated with deep hypothermia and circulatory arrest.
Main Methods:
- Review of deep hypothermia applications in various cardiac surgical procedures.
- Identification of key physiological parameters requiring monitoring during DH.
Main Results:
- DH is utilized in complex adult cardiac surgeries like aortic arch repair and acute aortic dissection.
- In congenital defect surgeries, DH supports aortic arch reconstruction and hypoplastic left heart syndrome interventions.
- Safe circulatory arrest duration under DH for the central nervous system is limited to 30-40 minutes.
Conclusions:
- Deep hypothermia is a vital technique in specialized cardiac surgeries, offering significant organ protection.
- Adherence to maximum circulatory arrest times and meticulous patient-specific monitoring (temperature, blood glucose, hematocrit, pH, cerebral oxygenation) are essential for safe DH implementation.
Abstract:
Hypothermia is defined as a decrease in body core temperature to below 35 °C. In cardiac surgery, four stages of hypothermia are distinguished: mild, moderate, deep, and profound. The organ protection offered by deep hypothermia (DH) enables safe circulatory arrest as a prerequisite to carrying out cardiac surgical intervention. In adult cardiac surgery, DH is mainly used in aortic arch surgery, surgical treatment of pulmonary embolism, and acute type-A aortic dissection interventions. In surgery treating congenital defects, DH is used to assist aortic arch reconstructions, hypoplastic left heart syndrome interventions, and for multi-stage treatment of infants with a single heart ventricle during the neonatal period. However, it should be noted that a safe duration of circulatory arrest in DH for the central nervous system is 30 to 40 min at most and should not be exceeded to prevent severe neurological adverse events. Personalized therapy for the patient and adequate blood temperature monitoring, glycemia, hematocrit, pH, and cerebral oxygenation is a prerequisite and indispensable part of DH.
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