Advertisement

Hypothermic circulatory arrest through the left chest

  • Joseph S. Coselli
Conference paper

Abstract

The concept of profound hypothermic circulatory arrest (HCA) through an anterior mediastinal approach has been a widely employed technique for the protection of the central nervous and other organ systems in the treatment of complex congenital and cardiac lesions, as well as aneurysms of the aortic arch. The application of this technique in the treatment of aortic disease through a posterolateral approach has received far less attention. The rationale for the use of hypothermic circulatory arrest in the treatment of patients with aortic pathology beyond the left subclavian artery includes proximal extension of the aortic pathology into the transverse aortic arch, the inability to safely place proximal aortic cross clamp for anatomical reasons (size, rupture, friability, scar tissue from prior operation), or the use of hypothermia as a modality for organ protection (most importantly, the spinal cord). A number of clinical reports have demonstrated the effective use of cardiopulmonary bypass, hypothermic circulatory arrest, and posterolateral exposure for procedures on the thoracic aorta for diverse aortic pathology (1–8). This report is a retrospective review of the author’s experience using HCA for patients requiring replacement of the descending thoracic or thoracoabdominal aorta through the left chest where proximal cross clamping was not feasible or aneurysmal disease extended into the transverse aortic arch. The technique was not employed primarily for spinal cord or other organ protection in patients in whom proximal cross clamping was possible.

Keywords

Aortic Arch Aortic Aneurysm Circulatory Arrest Thoracic Aortic Aneurysm Hypothermic Circulatory Arrest 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Crawford ES, Coselli JS, Safi HJ (1987) Partial cardiopulmonary bypass, hypothermic circulatory arrest, and posterolateral exposure for thoracic aortic aneurysm operation. J Thorac Cardiovasc Surg 94: 824–827PubMedGoogle Scholar
  2. 2.
    Westaby S (1992) Hypothermic thoracic and thoracoabdominal aneurysm operation: A central cannula-tion technique. Ann Thorac Surg 54: 253–258PubMedCrossRefGoogle Scholar
  3. 3.
    Kouchoukos NT, Daily BB, Rokkas, CK, Murphy SF, Bauer S, Abboud N (1995) Hypothermie bypass and circulatory arrest for operations on the descending thoracic and thoracoabdominal aorta. Ann Thorac Surg 60: 67–77PubMedGoogle Scholar
  4. 4.
    Kouchoukos NT, Wareing TH, Izumoto H, Klausing W, Abboud, N (1990) Elective hypothermic cardiopulmonary bypass and circulatory arrest for spinal cord protection during operations on the thoracoabdominal aorta. J Thorac Cardiovasc Surg 99: 659–664PubMedGoogle Scholar
  5. 5.
    Kieffer E, Koskas F, Waiden R et al. (1994) Hypothermie circulatory arrest for thoracic aneurysmectomy through left-sided thoracotomy. J Vasc Surg 19: 457–464PubMedCrossRefGoogle Scholar
  6. 6.
    Mahfood S, Qazi A, Garcia J, Mispireta L, Corso P, Smyth N (1985) Management of aortic arch aneurysm using profound hypothermia and circulatory arrest. Ann Thorac Surg 39: 412–417PubMedCrossRefGoogle Scholar
  7. 7.
    Massimo CG, Poma AG, Viligiardi RR, Duranti A, Colucci M, Favi PP (1986) Simultaneous total aortic arch replacement from arch to bifurcation: Experience with six cases. J Tex Heart Inst 13: 147–151Google Scholar
  8. 8.
    Szentpetery S, Crisler C, Grinnan GLB (1993) Deep hypothermic arrest and left thoracotomy for repair of difficult thoracic aneurysms. Ann Thorac Surg 55: 830–833PubMedCrossRefGoogle Scholar
  9. 9.
    Coselli JS (1992) Suprarenal Aortic Reconstruction: Perioperative Management: Patient Selection, Patient Workup, Operative Management, and Postoperative Management. Sem Vasc Surg 5(3): 146–156Google Scholar
  10. 10.
    Coselli JS (1992) Suprarenal Aortic Reconstruction: Endovascular Repair. Sem Vasc Surg 5(3): 180–191Google Scholar
  11. 11.
    Coselli JS (1994) Thoracoabdominal Aortic Aneurysm. In: Rutherford RB, ed. Vascular Surgery, 4th Ed. Philadelphia, PA: W.B. Saunders Company: 1069–1087Google Scholar
  12. 12.
    Coselli JS (1994) Thoracoabdominal aortic aneurysms: experience with 372 patients. J Card Surg 9: 638–647PubMedCrossRefGoogle Scholar
  13. 13.
    Coselli JS (1995) Surgical Technique, Preoperative and Intraoperative Management of Thoracoabdomi-nal Aortic Aneurysm. In: Yao JST and Pearce WH, eds. Arterial Surgery: Management of Challenging Problems. Norwalk, CT: Appleton & Lange: 223–235Google Scholar
  14. 14.
    Coselli JS, Crawford ES, Beall AC Jr, Mizrahi EM, Hess KR, Patel VM (1988) Determination of brain temperatures for safe circulatory arrest during cardiovascular operation. Ann Thorac Surg 45: 638–642PubMedCrossRefGoogle Scholar
  15. 15.
    Borst HG, Schaudig A, Rudolph W (1964) Arteriovenous fistula of the aortic arch: Repair during deep hypothermia and circulatory arrest. J Thorac Cardiovasc Surg 48: 443–447PubMedGoogle Scholar
  16. 16.
    Lillehei CW, Todd DB Jr, Levy MJ, Ellis RJ (1969) Partial cardiopulmonary bypass, hypothermia and total circulatory arrest. J Thorac Cardiovasc Surg 58: 530–544PubMedGoogle Scholar

Copyright information

© Dr. Dietrich Steinkopff Verlag GmbH & Co. KG, Darmstadt 1997

Authors and Affiliations

  • Joseph S. Coselli
    • 1
  1. 1.The Methodist Hospital/Baylor College of MedicineHoustonUSA

Personalised recommendations