Descending thoracic and thoracoabdominal aortic aneurysm repair using deep hypothermic circulatory arrest

Descending thoracic and thoracoabdominal aortic replacement is a complex and high-risk surgery. Deep hypothermic circulatory arrest (DHCA) is a surgical technique that is useful in large distal aortic arch aneurysms or chronic dissections that require fenestration where proximal cross clamping would be difficult. It can also be used as part of a multimodal strategy for end-organ protection. However, DHCA has potential adverse effects on the myocardial, cerebral, pulmonary, and coagulation systems. The use of DHCA is guided by the experience and preferences of the surgical team as well as the technical demands of the proposed surgery.