Hypothermia and circulatory arrest for surgical resection of aortic arch aneurysms

Selective cerebral perfusion via innominate artery in aortic arch replacement without deep hypothermic circulatory arrest

“…Despite remarkable achievements from Cooley and De Bakey [1,2], Cooley et al [3], Alley et al [4], and Bahnson [5], in the early years of thoracic aortic surgery operations on the aortic arch were still a high risk for many years to come. The tln'ee essential causes were myocardial injury, cerebral injury, and hemorrhagic complications [6]. Due to improved methods of cardioplegia, the myocardial injury decreased as an essential factor.…”

“…Due to improved methods of cardioplegia, the myocardial injury decreased as an essential factor. An ~mprovement of the cerebral protection strategy was achieved by introducing deep hypothermia and circulatory arrest [6][7][8][9]. In t975, Griepp et al [10] first reported on the clinical use of deep hypothermic circulatory arrest during aortic arch replacement.…”

“…In t975, Griepp et al [10] first reported on the clinical use of deep hypothermic circulatory arrest during aortic arch replacement. Despite reports from Livesay et al, [11] and Crawford and Snyder [12] about reduced risks in thoracic aortic operations due to the reliability of this perfusion method, there was still controversy over the method, owing to continual reports about clotting disturbances [6,13].…”

“…The increased use of deep hypothermic circulatory arrest during ascending aortic arch replacement not only distinctly decreased hospital mortality ram from 50% to under 20% [7,14,15] (even to under 5% [12] in single series) but also the incidences of neurological complications as essential mortality factors [6,16] were drastically diminished [17][18][19]. Despite these considerable improvements, methods of improving cerebral protection were being permanently de- veloped because deep hypothermic circulatory arrest allowed only a time-limited "safe" brain protection, with dependence on body-core temperature.…”

“…Despite these considerable improvements, methods of improving cerebral protection were being permanently de- veloped because deep hypothermic circulatory arrest allowed only a time-limited "safe" brain protection, with dependence on body-core temperature. A time interval of up to 60 minutes at 15-18°C [6,20] is generally recognized as safe protection; however, this period may be insufficient for an optimum aortic arch replacement, especially with giant aneurysms or large dissections up to the distal arch. In order to avoid this time limit, the selective cerebral perfusion (SCP) was modified [6,13,14,21], as described by Cooley's group [8,22] prior to the establishment of deep hypothermic circulatory arrest and continual retrograde cerebral perfusion (CRCP), developed by others [7,[23][24][25][26][27].…”