Cardiovascular surgical repair of arch aneurysms is taking a step forward by going backwards by utilizing retrograde cerebral perfusion. Drs ME DeBakey, ES Crawford, DA Cooley and GC Morris first reported successful resection and repair of a fusiform aneurysm of the aortic arch with replacement graft in 1957.1 Since then, Crawford and Coselli have pursued materials and techniques which have made this procedure, one which generally resulted in high morbidity and mortality, more viable with decreased morbidity and mortality. Increased numbers of patients are now having this repair and are resuming normal healthy lives after the operation. From February 1992 to October 1993, 88 patients were surgically treated by Coselli who utilized retrograde cerebral perfusion with profound hypothermia and circulatory arrest, thus allowing for repairs that under any other conditions probably could not have been achieved successfully. It is evident that a major determinant for the successful clinical results, in addition to surgical technique and skill, was the employment of profound hypothermia and circulatory arrest. This article will review the techniques and results of aortic arch repair utilizing retrograde cerebral perfusion during circulatory arrest with profound hypothermia to lessen the chance of neurological morbidity following surgical replacement of the transverse aortic arch.
Experience with profound hypothermia and circulatory arrest in the treatment of aneurysms of the aortic arch
