Experience with profound hypothermia and circulatory arrest in the treatment of aneurysms of the aortic arch. Aortic arch replacement for acute arch dissections

In a series of 21 consecutive patients, the aortic arch, varying portions of the ascending and descending aorta, and in some the aortic valve were replaced with the aid of a standard method of profound total body hypothermia and circulatory arrest. Fourteen patients underwent elective and 7 patients emergency arch replacement. A combination of surface cooling and cardiopulmonary bypass was used to produce total body hypothermia. Replacement of the aortic arch was performed during a single period of circulatory arrest. Cardiopulmonary bypass was utilized for core rewarming. The average cerebral ischemic time was 37 ± 14 minutes at an average core temperature of 13.7° ± 1.8°C. The average myocardial ischemic time was 79 ± 28 minutes with an average duration of cardiopulmonary bypass of 130 ± 32 minutes. Of the 14 patients undergoing elective operation, 3 died; of the 7 patients undergoing emergency operations, 3 died (2 with ruptured aneurysms and 1 with acute arch dissection). Fifteen patients are alive and well 2 months to 7 years following the operation. All are free of neurologic sequelae. One has an asymptomatic residual dissection in the descending aorta. This experience indicates that profound total body hypothermia with circulatory arrest is a safe and effective method for elective surgical treatment of enlarging aneurysms of the aortic arch and for emergency treatment of acute dissections if the intimal tear is located in the aortic arch. The technique is simple and produces results superior to those reported for methods which involve selective cerebral perfusion during arch replacement.