Hypothermic circulatory arrest for thoracic aneurysmectomy through left-sided thoracotomy

Area of Science:

• Cardiovascular Surgery
• Thoracic Surgery
• Aortic Aneurysm Management

Background:

• Complex aortic aneurysms often require advanced surgical techniques for optimal outcomes.
• Left thoracotomy provides access but can present challenges in aortic arch and thoracoabdominal repairs.
• Hypothermic circulatory arrest (HCA) is an established method for cerebral and systemic protection during complex aortic procedures.

Purpose of the Study:

• To clarify the role and outcomes of hypothermic circulatory arrest (HCA) in managing complex aortic aneurysms.
• To evaluate the technique of HCA in patients undergoing left thoracotomy for thoracic or thoracoabdominal aortic aneurysms.

Main Methods:

• Retrospective review of 87 complex aortic aneurysm surgeries over 21 months.
• HCA was utilized in 15 cases (17%), primarily for descending thoracic or thoracoabdominal aortic aneurysms.
• Deep hypothermia (15-24°C) was induced via partial cardiopulmonary bypass; indications included proximal disease and need for arch replacement.

Main Results:

• Three in-hospital deaths occurred (rupture, bleeding, left ventricular failure).
• One patient developed delayed paraplegia; all other survivors were neurologically intact.
• Eleven patients experienced successful perioperative outcomes without significant morbidity.

Conclusions:

• Hypothermic circulatory arrest (HCA) is a valuable adjunct for complex aortic aneurysms treated via left thoracotomy.
• HCA facilitates management of dissections and aneurysms involving the aortic arch and thoracoabdominal aorta.
• Selective use of HCA is warranted for spinal cord and visceral protection in challenging aortic surgeries.