European Journal of Cardio-Thoracic Surgery, Vol 11, 176-181, Copyright © 1997 by European Association for Cardio-thoracic Surgery
The use of profound hypothermia and circulatory arrest in operations on the thoracic aorta
M Ehrlich, M Grabenwoger, D Luckner, F Cartes-Zumelzu, P Simon, G Laufer, E Wolner and M Havel
Department of Cardio-Thoracic Surgery, University of Vienna, Austria.
OBJECTIVE: This retrospective study reviews the contemporary surgical
outcome of our patients undergoing operations on thoracic aneurysms in deep
hypothermic circulatory arrest. METHODS: Between January 1989 and February
1995, 279 patients were operated on in our institution on various portions
of the aorta. In 143 patients (97 male, 46 female), deep hypothermia and
circulatory arrest were used as the standard operative technique. Patients
age ranged from 16 to 83 years (mean 55). Final indication for operation
was dissection Type A in 80 patients (61 acute, 19 chronic), dissection
Type B in 21 patients (17 acute, 4 chronic) and atherosclerotic aneurysms
in 42 patients (11 acute, 31 chronic). 16 patients were operated under
preoperative unstable hemodynamic conditions, 6 patients had been
resuscitated preoperatively. Surgical technique included cardiopulmonary
bypass with femoral artery cannulation. For added cerebral protection all
patients received Cortisone and barbiturates right before circulatory
arrest (confirmed by 0-EEG). The segment of the aorta containing the area
with the aneurysm, was resected and replaced with a tubular albumin coated
graft. RESULTS: The 30-day mortality was 31.15% (19/61) in the acute and
23.52% (4/19) in the chronic type A dissection group, 35.29% (6/17) in the
acute and 25% (1/4) in the chronic type B group, 36.3% (4/11) in the acute
and 22.58% (7/31) in the chronic atherosclerotic group. Causes of
postoperative death in order of frequency were: multiorgan failure (n =
15), myocardial failure (n = 13), bleeding (n = 4), sepsis (n = 4),
myocardial infarction (n = 3) and stroke (n = 2). CONCLUSION: Despite
rather high mortality rates in the acute aneurysm groups, the technique of
profound hypothermic circulatory arrest represents a relatively safe method
for operations on the thoracic aorta.
