Partial cardiopulmonary bypass, hypothermia, and total circulatory arrest

Progress in the treatment of thoracic aortic aneurysms

“…The latter technique has also proven useful in the treatment of patients through posterolateral chest or thoracoabdominal incisions [15,18,23]. The indications for its use in this setting include: chest entry or aortic exploration and replacement for contained rupture of aneurysms of the descending thoracic or thoracoabdominal aortic segments and aneurysms of the descending thoracic aorta that are so large that chest entry or proximal aortic exposure for clamping is unsafe or impossible; to avoid clamping the distal aortic arch in patients with athero-matous intimal disease that could cause cerebral embolization; in patients in whom the proximal ascending aorta cannot be safely separated from the left pulmonary artery and in patients in whom the pulmonary artery or distal aortic arch is lacerated during exposure or clamping; and finally, for exposure in patients in whom it is desirable to replace long segments including ascending, arch, and distal aortic segments at one operation.…”

“…Recently developed methods of successful management of this complication represent a remarkable advance in the treatment of infected grafts. Treatment consists of exposure using femoral vein-femoral artery partial cardiopulmonary bypass, profound hypothermia, and circulatory arrest [20,23]. The wound is opened and the clot removed.…”

“…Hypothermia is usually achieved in these cases by total cardiopulmonary bypass, cannulating the cavae in the chest and the common femoral artery in the groin. It may be produced by femoral vein-femoral artery partial cardiopulmonary bypass without left ventricular decompression [18,20,23]. This variation has allowed safe anterior chest entry in patients with large ascending or arch aneurysms, those who had previous operations, and in cases with false aneurysms with or without infection of mediastinum and midsternal wounds [20,23].…”

Progress in treatment of aneurysms of the aortic arch

“…Deep hypothermia offers an alternative to cerebral perfusion for preservation of the central nervous system during the period of exclusion of the aortic arch, without the inherent risks of the latter technique. Profound hypothermia and circulatory arrest for repair of congenital heart lesions in infancy has been widely accepted [24] and several reports indicate that the technique is also feasible in adults [25,26]. The first application of this modality for replacement of the aortic arch, reported by Nicks [27] in 1972, ended in failure.…”