Straight deep hypothermic circulatory arrest for cerebral protection during aortic arch surgery: Safe and effective

Objective: To evaluate our extensive clinical experience using deep hypothermic circulatory arrest (DHCA) as a sole method of cerebral protection during aortic arch surgery, with an emphasis on determining the safe duration of DHCA. Methods: A total of 490 consecutive patients (303 males [61.8%], mean age, 62.7 +/- 13.5 years) underwent surgical interventions on the aortic arch with straight DHCA for cerebral protection. Of the procedures, 65 (13.3%) were either urgent or emergency. Aortic aneurysms (n = 417, 85.1%) and dissections (n = 71, 14.5%) were the main indications for surgery. Results: The mean DHCA duration was 29.2 +/- 7.9 minutes at a mean bladder temperature of 18.7 degrees C. The overall mortality was 2.4% (12 of 490), and elective mortality was 1.4% (6 of 425). The seizure rate was 1.4% (7 of 490). Six patients (1.2%) developed renal failure that required dialysis. The postoperative stroke rate was 1.6% (8 of 490) and was 1.2% (5 of 425) for the elective cases. The overall stroke rate for patients requiring <50 minutes of DHCA was 1.3% (6 of 478), significantly different from the 16.7% (2 of 12) stroke rate for patients requiring >50 minutes of DHCA (P = .014). Multivariate analysis revealed a DHCA time >50 minutes (odds ratio, 5.11 +/- 4.01, P = .038) and aortic dissection (odds ratio, 3.59 +/- 1.72, P = .008) to be strong predictors of composite adverse outcomes. Conclusions: Straight DHCA is a safe and effective technique of cerebral protection for the absolute majority of interventions involving the aortic arch. At experienced centers, up to 50 minutes of DHCA can be considered safe, without significant postoperative mortality or neurologic sequelae.