Hypothermic circulatory arrest through the left chest

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.