Open repair of descending and thoracoabdominal aortic aneurysms under deep hypothermic circulatory arrest

Area of Science:

• Cardiovascular Surgery
• Thoracic Surgery
• Vascular Surgery

Background:

• Aortic arch pathologies, including DTA and TAA, require complex surgical repair.
• Deep hypothermic circulatory arrest (DHCA) is a technique used during aortic surgeries.
• Understanding the protective mechanisms and outcomes of DHCA is crucial.

Purpose of the Study:

• To evaluate the safety and efficacy of DHCA in aortic dissection (DTA) and total arch anomaly (TAA) repair.
• To assess the physiological protective effects of DHCA on cerebral, spinal cord, and visceral organs.
• To compare outcomes of DHCA versus non-DHCA in aortic surgery.

Main Methods:

• Review of large animal models to elucidate physiological protective mechanisms of DHCA.
• Analysis of clinical data comparing selective and routine DHCA use in DTA and TAA repairs.
• Comparison of early- and late-mortality, spinal cord protection, and visceral protection between DHCA and non-DHCA groups.

Main Results:

• DHCA demonstrated physiological protection for the brain, spinal cord, and visceral organs in animal models.
• Safety of DHCA was confirmed in both selective and routine use for DTA and TAA repairs.
• Similar early- and late-mortality rates were observed for DHCA and non-DHCA.
• Improved spinal cord and visceral protection were associated with DHCA compared to non-DHCA.
• A prolonged hospital stay was noted in certain series utilizing DHCA.

Conclusions:

• DHCA is a valuable adjunct for DTA and TAA repair, providing significant organ protection.
• DHCA is safe and comparable in mortality to non-DHCA, with enhanced protection for the spinal cord and viscera.
• Potential for prolonged hospitalization should be considered when employing DHCA in aortic surgery.