Repair of Thoracic Aortic Aneurysm and Dissection Using Deep-Hypothermic Circulatory Arrest

Abstract

From October 1989 to September 1997, 14 patients underwent repair of a thoracic aortic aneurysm or dissection using deep-hypothermic circulatory arrest. There were 10 males and 4 females with a mean age of 58 years (range, 43 to 82 years). The diagnoses included one ascending aortic aneurysm, one ascending aortic and arch aneurysm, 2 aortic arch and descending aortic aneurysms, 4 descending aortic aneurysms, 2 chronic aortic dissections of type A and 4 of type B. The involved aortic segment was replaced with a woven Dacron tube graft in 11 patients and repaired with a patch of woven Dacron in the other 3. Concomitant procedures were coronary artery bypass grafting in 2 cases; one aortic valve replacement, and one wedge resection of the left-upper lobe of the lung. A median sternotomy approach was used in 6 patients of whom 5 had right atrial-femoral artery bypass and 1 had right atrial-ascending aortic bypass. In addition to sternotomy, one patient had a left anterolateral thoracotomy. Seven patients had a left posterolateral thoracotomy with femorofemoral bypass. The mean circulatory arrest time was 35 minutes (range, 13 to 59 minutes). The lowest perfusion temperature ranged from 7°C to 16°C. Retrograde cerebral perfusion was used in 5 patients. There was one operative death from massive bleeding. Early complications included stroke in 2 patients, vocal cord paralysis in one, prolonged ventilatory support in one, reoperation for bleeding in one, and pleural effusion in 3 patients. There were 2 late deaths and the 11 surviving patients (78%) have been followed up for a mean period of 18 months. Deep-hypothermic circulatory arrest was found to be a useful technique in the repair of aortic aneurysm and dissection. We consider retrograde cerebral perfusion to be safe and easily performed. It probably decreased the incidence of stroke in patients with involvement of the aortic arch.