The use of profound hypothermia and circulatory arrest in operations on the thoracic aorta

This retrospective study reviews the contemporary surgical outcome of our patients undergoing operations on thoracic aneurysms in deep hypothermic circulatory arrest.

Between January 1989 and February 1995, 279 patients were operated on in our institution on various portions of the aorta. In 143 patients (97 male, 46 female), deep hypothermia and circulatory arrest were used as the standard operative technique. Patients age ranged from 16 to 83 years (mean 55). Final indication for operation was dissection Type A in 80 patients (61 acute, 19 chronic), dissection Type B in 21 patients (17 acute, 4 chronic) and atherosclerotic aneurysms in 42 patients (11 acute, 31 chronic). 16 patients were operated under preoperative unstable hemodynamic conditions, 6 patients had been resuscitated preoperatively. Surgical technique included cardiopulmonary bypass with femoral artery cannulation. For added cerebral protection all patients received Cortisone and barbiturates right before circulatory arrest (confirmed by 0-EEG). The segment of the aorta containing the area with the aneurysm, was resected and replaced with a tubular albumin coated graft.

The 30-day mortality was 31.15% (19/61) in the acute and 23.52% (4/19) in the chronic type A dissection group, 35.29% (6/17) in the acute and 25% (1/4) in the chronic type B group, 36.3% (4/11) in the acute and 22.58% (7/31) in the chronic atherosclerotic group. Causes of postoperative death in order of frequency were: multiorgan failure (n = 15), myocardial failure (n = 13), bleeding (n = 4), sepsis (n = 4), myocardial infarction (n = 3) and stroke (n = 2).

Despite rather high mortality rates in the acute aneurysm groups, the technique of profound hypothermic circulatory arrest represents a relatively safe method for operations on the thoracic aorta.