Surgical treatment of aneurysms of the transverse aortic arch: experience with 25 patients using hypothermic...

Surgical treatment of aneurysms of the transverse aortic arch has been a challenge to cardiovascular surgeons. The problems include protection of the brain and spinal cord from ischemic or embolic injury, prevention of hemorrhage and coagulopathy, and prevention of myocardial damage during prolonged extracorporeal circulation. Two methods are described. Group 1 included 20 patients in whom deep hypothermic conditions were induced (12 degree to 16 degree C) followed by circulatory arrest and partial exsanguination. In this group a 50% hospital mortality occurred. Patients in Group 2 underwent moderate induced hypothermia (24 degree to 26 degree C) with continuous cerebral perfusion during the period of peripheral circulatory arrest. Four of 5 patients survived this technique, leading us to believe this method is preferred over the deeper levels of hypothermia. A method of preclotting the Dacron graft with platelet-rich plasma and autoclaving is described. It has eliminated interstitial bleeding through fabric grafts.