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. 2013 May;2(3):303-15.
doi: 10.3978/j.issn.2225-319X.2013.01.05.

Deep hypothermic circulatory arrest

Bulat A Ziganshin  1 , John A Elefteriades
Affiliations

Deep hypothermic circulatory arrest

Bulat A Ziganshin et al. Ann Cardiothorac Surg. 2013 May.

Abstract

Effective cerebral protection remains the principle concern during aortic arch surgery. Hypothermic circulatory arrest (HCA) is entrenched as the primary neuroprotection mechanism since the 70s, as it slows injury-inducing pathways by limiting cerebral metabolism. However, increases in HCA duration has been associated with poorer neurological outcomes, necessitating the adjunctive use of antegrade (ACP) and retrograde cerebral perfusion (RCP). ACP has superseded RCP as the preferred perfusion strategy as it most closely mimic physiological perfusion, although there exists uncertainty regarding several technical details, such as unilateral versus bilateral perfusion, flow rate and temperature, perfusion site, undue trauma to head vessels, and risks of embolization. Nevertheless, we believe that the convenience, simplicity and effectiveness of straight DHCA justifies its use in the majority of elective and emergency cases. The following perspective offers a historical and clinical comparison of the DHCA with other techniques of cerebral protection.

Keywords: Deep hypothermic circulatory arrest; aortic arch surgery; cerebral perfusion; neuroprotection.

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Figures

Figure 1
Figure 1
Drop in cerebral metabolic rate (to 12% of normothermic levels @ 18 °C) with hypothermia. [Reprinted with permission from Kirklin JW, Barratt-Boyes BG. Cardiac surgery: morphology, diagnostic criteria, natural history, techniques, results, and indications. 2nd ed. New York: Churchill Livingstone; 1993 (14)]
Figure 2
Figure 2
Distribution of DHCA time of all operated patients. [Reprinted with permission from Gega et al. (15)]
Figure 3
Figure 3
A. Traditional technique of aortic arch reconstruction; B. Our preferred alternative technique of arch reconstruction with a 2-vessel Carrel patch. [Reprinted with permission from Ziganshin et al. (16)]
Figure 4
Figure 4
Preoperative and postoperative questionnaire responses of patients undergoing aortic surgery with DHCA. Results show no difference between patients operated with or without DHCA. [Reprinted with permission from Percy et al. (47)]
See this image and copyright information in PMC

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