The History of Deep Hypothermic Circulatory Arrest in Thoracic Aortic Surgery

Abstract

Depending on the extent of aortic disease and surgical repair required, thoracic aortic surgery often involves periods of reduced cerebral perfusion. Historically, this resulted in detrimental neurological dysfunction, and high risk of mortality and morbidity. Over the last half century, rapid improvements have revolutionized aortic surgery. Among these, deep hypothermic circulatory arrest (DHCA) has drastically reduced the risk of mortality and morbidity following surgery on the thoracic aorta. This progress was facilitated by experimental pioneers such as Bigelow, who studied reduced oxygen expenditure consequent on induction of hypothermia in dogs. These encouraging findings led to trials in human cardiac surgery by Lewis in 1952 and further made possible the first successful aortic arch replacement by Denton Cooley and Michael De Bakey. Modern day surgery has come a long way from the use of immersion of the patient in ice baths and other primitive techniques previously described. This paper explores the development of deep hypothermic circulatory arrest from its origins to the present.

Keywords: Aortic aneurysm; Cerebral protection; Deep hypothermic circulatory arrest; History; Thoracic aortic surgery.

Figure 1.

Wilfred G. Bigelow (1913-2005), initiated cardiac surgery under hypothermia. Reproduced with permission [8].

Figure 2.

Open-heart surgery performed in 1955. The patient is currently submerged in an ice bath. Courtesy of the US National Library of Medicine.