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Ann Thorac Surg 2001;71:1900-1904
© 2001 The Society of Thoracic Surgeons

Original article: cardiovascular

Closed chest hypothermic circulatory arrest for complex intracranial aneurysms

Malek G. Massad, MDa, Fady T. Charbel, MDb, Rabih Chaer, MDa, Alexander S. Geha, MDa, James I. Ausman, MD, PhDb

a Division of Cardiothoracic Surgery, Department of Surgery, The University of Illinois at Chicago, Chicago, Illinois, USA
b Department of Neurosurgery, The University of Illinois at Chicago, Chicago, Illinois, USA

Accepted for publication March 2, 2001.

Address reprint requests to Dr Massad, Division of Cardiothoracic Surgery (MC 958), University of Illinois at Chicago, 840 S Wood St, Suite 417, Chicago, IL 60612
e-mail: mmassad{at}uic.edu

Background. Recent advances in techniques of cardiopulmonary bypass permitted hypothermic circulatory arrest (HCA) using groin cannulation with the chest closed (CC-HCA) and without direct access to the heart. Herein we describe our experience with this technique for complex intracranial aneurysms.

Methods. Between 1992 and 1999, 16 patients (4 men and 12 women) with a mean age of 52 years (range 32 to 61 years) with complex intracranial aneurysms underwent resection or clipping of their aneurysms at our institution using the technique of CC-HCA and groin cannulation. Groin access was obtained with 16F to 19F arterial and 18F to 20F venous cannulas placing the tips at the aortoiliac and atriocaval junctions, respectively. Patients were cooled to a nasopharyngeal temperature of 16°C.

Results. Mean circulatory arrest time was 32 minutes. No patient required conversion to standard sternotomy and central cannulation. There were no intraoperative deaths. The 30-day hospital mortality was 2 of 16 patients (12%). Of the 14 surviving patients (88%), 1 developed bilateral third nerve palsy and another left hemiparesis that improved on follow-up. Both were discharged to an extended care facility and continued to do well at home after discharge. Two patients developed deep venous thrombosis postoperatively and required anticoagulation. All patients continued to do well at a mean follow-up of 42 months.

Conclusions. The less invasive technique of CC-HCA through groin cannulation avoids complications associated with a sternotomy, is safe and is associated with little morbidity, reduced operative time, and early hospital discharge and rehabilitation.






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