Progress in treatment of aneurysms of the aortic arch

Abstract

A review of past and current operative procedures for treatment of aneurysms of the aortic arch is presented in conjunction with a series of 14 patients in whom the aortic arch and variable portions of the ascending and descending aorta were replaced utilizing a combination of surface cooling and cardiopulmonary bypass to produce profound total body hypothermia. Arch replacement was carried out during a single period of circulatory arrest. Cardiopulmonary bypass was then utilized to warm the patient and resuscitate the heart. The average cerebral ischemia time was 42 minutes at an average core temperature of 14°C. The average myocardial ischemia time was 68 minutes, and the average duration of cardiopulmonary bypass was 122 minutes. There were 4 deaths in this series. Of the I0 patients undergoing elective operation only 1 died. The remaining patients are alive and well 4 months to 6 years following surgery. This experience indicates that by utilizing total body hypothermia and circulatory arrest, aortic arch replacement can be carried out with superior results. This technique is our method of choice and should find increasing application.

The Use of Retrograde Cerebral Perfusion in a Patient with Acute Ascending Aortic Dissection Following Elective Coronary Bypass Surgery :A Case Report.

“…Deep hypothermic circulatory arrest without retrograde cerebral perfusion and isolated partial cerebral ante grade perfusion is a technique that is commonly used but has many risks associated with it. (1)(2)(3). While deep hypothermic circulatory arrest provides a dry surgical field, cerebral preservation must be of prime concern.…”