Deep hypothermic arrest and left thoracotomy for repair of difficult thoracic aneurysms

Seven patients with complex thoracic aortic aneurysms were operated on using profound hypothermia and circulatory arrest through a left thoracotomy. Three patients had false aneurysms, 2 had large aneurysms precluding access for proximal control, 1 patient had had previous hemiarch replacement, and 1 patient had a thoracoabdominal aneurysm. All patients were cooled on partial cardiopulmonary bypass until the electroencephalogram was isoelectric (approximately 15 degrees C rectal temperature). Circulatory arrest times ranged from 7 to 56 minutes (median, 34 minutes). There was one death due to cardiac failure, and paraplegia developed in 1 patient. The 6 survivors are otherwise well at a median of 12 months postoperatively. Hypothermia and circulatory arrest is an invaluable technique for the treatment of complex aortic aneurysms requiring left thoracotomy for resection. The techniques employed are described and the indications for their use are discussed.