New Frontiers in Aortic Therapy: Focus on Deep Hypothermic Circulatory Arrest

• Published in: Journal of cardiothoracic and vascular anesthesia Vol. 28; no. 4; pp. 1159 - 1163
• Main Authors: Gutsche, Jacob T., MD, Ghadimi, Kamrouz, MD, Patel, Prakash A., MD, Robinson, Albert R., MD, Lane, Bernard J., MD, Szeto, Wilson Y., MD, Augoustides, John G.T., MD, FASE, FAHA
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.08.2014
• Subjects: adult aortic arch repair; Anesthesia & Perioperative Care; antegrade cerebral perfusion; Aortic Aneurysm, Thoracic - surgery; cardiopulmonary bypass; Cerebrovascular Circulation - physiology; Circulatory Arrest, Deep Hypothermia Induced - trends; clinical registry; Critical Care; deep hypothermic circulatory arrest; expert consensus; Humans; hybrid aortic arch repair; international aortic arch surgery study group; meta-analysis; mild hypothermia; moderate hypothermia; randomized controlled trial; retrograde cerebral perfusion; stroke; temporary neurologic dysfunction; Vascular Surgical Procedures; retrograde cerebral perfusion; adult aortic arch repair; international aortic arch surgery study group; deep hypothermic circulatory arrest; hybrid aortic arch repair; meta-analysis; clinical registry; stroke; randomized controlled trial; antegrade cerebral perfusion; expert consensus; temporary neurologic dysfunction; mild hypothermia; cardiopulmonary bypass; moderate hypothermia
• ISSN: 1053-0770; 1532-8422
• DOI: 10.1053/j.jvca.2014.03.018

There is currently a paradigm shift in the conduct of adult aortic arch repair. Although deep hypothermic circulatory arrest has been the classic perfusion platform for adult aortic arch repair, recent developments have challenged this aortic arch paradigm. There has been a gradual clinical drift towards moderate, and even mild, hypothermic circulatory arrest combined with antegrade cerebral perfusion. This paradigm shift appears to be associated with equivalent clinical outcomes, and in certain settings, with improved outcomes. The advent of endovascular therapy has challenged even further the concept that circulatory arrest is required for adult aortic arch repair. These dramatic advances have resulted in the emergence of an international aortic arch surgery study group that aims to advance this dynamic field through consensus statements, meta-analysis, clinical database analysis, prospective registries, and randomized controlled trials.