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Harmik J. Soukiasian, MD; Sharo S. Raissi, MD; Thomas Kleisli, BS; Alan T. Lefor, MD, MPH; Gregory P. Fontana, MD; Lawrence S. C. Czer, MD; Alfredo Trento, MD

Arch Surg. 2005;140:394-398.

Hypothesis  Hypothermic total circulatory arrest (TCA) in the resection and replacement of the thoracoabdominal and descending thoracic aorta is safe, will significantly decrease the incidence of postoperative renal failure, and should be preferentially performed over left heart bypass (LHB).

Design  Retrospective review case series.

Setting  Large, private, urban teaching hospital.

Patients  All adult patients with aortic disease that involved the distal aortic arch, the descending thoracic aorta, or the thoracoabdominal aorta who underwent resection and graft replacement of the diseased segment via LHB or TCA at our institution from 1989 to 2001 are included in this study. A total of 59 patients were evaluated: 10 had descending thoracic aneurysms, 20 had thoracoabdominal aneurysms, 22 had chronic type B dissections, 4 had acute type B dissections, and 3 had adult coarctations.

Interventions  In 1989 to 1994, LHB was primarily used; in 1994 to 2001, TCA was primarily used.

Main Outcome Measures  Renal failure, 30-day operative mortality, paraplegia, and any other morbidities.

Results  A significant decrease occurred in the incidence of postoperative renal failure from 15% (3/20) in patients who underwent LHB to 0% (0/39) in patients who underwent TCA (P = .04). Furthermore, a significant decrease occurred in the 30-day operative mortality, which decreased from 20% (4/20) in patients who underwent LHB to 5% (2/39) in patients who underwent TCA (P = .04). Postoperative paraplegia decreased from 5% (1/20) in patients who underwent LHB to 2.6% (1/39) in patients who underwent TCA (P > .99).

Conclusions  Our use of TCA in the resection and replacement of the diseased thoracoabdominal and descending thoracic aorta has produced excellent results. Our patients have experienced no postoperative renal failure and a low 30-day operative mortality. The use of TCA in this patient population is a viable option for surgeons comfortable with the technique.

Author Affiliations: Department of Surgery, Division of Cardiothoracic Surgery, Cedars-Sinai Medical Center, Los Angeles, Calif.

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