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The Journal of Cardiovascular Surgery 2022 Mar 03

DOI: 10.23736/S0021-9509.22.12275-5


lingua: Inglese

Duration of Deep Hypothermic Circulatory Arrest (DHCA) for aortic arch surgery: is it a myth, fiction, or scientific leap?

Sven Z. TAN 1, Sidhant SINGH 1, Natasha J. AUSTIN 1, Joaquin ALFONSO PALANCA 1, Matti JUBOURI 2, Leonard N. GIRARDI 3, Edward CHEN 4, Mohamad BASHIR 5

1 Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK; 2 Hull York Medical School, University of York, York, UK; 3 Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, USA; 4 Division of Cardiovascular and Thoracic Surgery, Duke University Medical Center, DUMC 3442, Durham, NC, USA; 5 Vascular and Endovascular Surgery, Health & Education Improvement Wales, Wales, UK


BACKGROUND: The use of deep hypothermic circulatory arrest (DHCA) to provide aortic surgeons with a bloodless operative field while simultaneously protecting the brain and peripheries from ischaemic damage revolutionised cardiac and aortic surgery, and is currently used in specialist centres across the globe. However, it is associated with manifold adverse outcomes, including neurocognitive dysfunction and mortality. This review seeks to analyse the relationship between DHCA duration and clinical outcome, and evaluate the controversies and limitations surrounding its use.
METHODS: We performed a review of available literature with statistical analysis to evaluate the relationship between DHCA duration (< 40 min and > 40 min) and key clinical outcomes, including mortality, permanent and temporary neurological deficit, renal damage, admission length, and reintervention rate. The controversies surrounding DHCA use and future directions for care are also explored.
RESULTS: Statistical analysis revealed no significant association (P > 0.05) between DHCA duration and clinical outcomes (early and late mortality rates, neurological deficit, admission length, and reintervention rate), both with and without adjunctive perfusion techniques.
CONCLUSIONS: Available literature suggests that the relationships between DHCA duration (with and without adjunctive perfusion) and clinical outcomes are unclear, and at present not statistically significant. Alternative surgical and endovascular techniques have been identified as promising novel approaches not requiring DHCA, as have the use of biomarkers to enable early diagnosis and intervention for aortic pathologies.

KEY WORDS: Deep hypothermic circulatory arrest; Aortic arch repair; Neuroprotection

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