Aortic arch repair — Report of experiences with deep hypothermic circulatory arrest and with retrograde cerebral perfusion

Aortic arch surgery poses a number of technical problems not the least of which are cerebral preservation and haemostasis. Traditional approaches using bypass shunts or arch-vessel perfusion are cumbersome and have a significant cerebral morbidity. Deep hypothermia and circulatory arrest provide ideal conditions for up to one hour to allow repair of the arch. This technique was used in 12 patients being operated on for aneurysms and dissections of the aortic arch in 1991. There were three deaths in the early post-operative period. Deep hypothermia and circulatory arrest was found to be particularly useful for acute Type A dissection, re-operative aortic surgery and aneurysms of the distal arch not amenable to the routine cross-clamp technique. In two cases retrograde cerebral perfusion was used.