HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Sary F. Aranki Meena Nathan Prem Shekar Gregory Couper Robert Rizzo Lawrence H. Cohn Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Aranki, S. F. Articles by Cohn, L. H. Search for Related Content PubMed PubMed Citation Articles by Aranki, S. F. Articles by Cohn, L. H. Related Collections Valve disease

Ann Thorac Surg 2005;80:1679-1687
© 2005 The Society of Thoracic Surgeons

---

Original article: Cardiovascular

Hypothermic Circulatory Arrest Enables Aortic Valve Replacement in Patients With Unclampable Aorta

Division of Cardiac Surgery, Brigham and Women's Hospital, Boston, Massachusetts

Accepted for publication March 18, 2005.

^_* Address correspondence to Dr Aranki, Division of Cardiac Surgery, Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115 (Email: saranki{at}partners.org).

Presented at the Forty-first Annual Meeting of The Society of Thoracic Surgeons, Tampa, FL, Jan 24–26, 2005.

BACKGROUND: Atheroembolic complications associated with clamping a severely diseased ascending aorta during aortic valve replacement may result in unacceptable mortality and morbidity. Different management options include hypothermic circulatory arrest to replace the aortic valve, an aortic endarterectomy, or tube graft replacement of the aorta to allow safe application of cross-clamp before aortic valve replacement.

METHODS: From1998 to 2004, 70 patients who underwent aortic valve replacement had an aorta that was unclampable. Median age was 76 years; 33 (47%) were women; 46 (66%) had concomitant coronary artery bypass grafting; 9 (13%) had concomitant mitral valve surgery; and 4 (6%) were reoperations. Hypothermic circulatory arrest was used to replace the aortic valve alone, to do an aortic endarterectomy, or replace the ascending aorta with a tube graft.

RESULTS: Operative mortality was 4%. There were 8 (11%) strokes and 1 (1.4%) transient ischemic attack. Statistical analysis showed no association between circulatory arrest period and occurrence of adverse cerebral events. There was no significant difference among the three groups when operative mortality and cerebral events were compared.

CONCLUSIONS: Hypothermic circulatory arrest is an important adjunct that allows aortic valve replacement to be performed with an acceptable mortality but with an increased risk of cerebral event in this high-risk and elderly group of patients.

This article has been cited by other articles:

				A. Mommerot and L. P. Perrault Use of Aortic Connector Device for Porcelain Aorta: To Touch or Not to Touch? That is the Question Ann. Thorac. Surg., July 1, 2007; 84(1): 355 - 355. [Full Text] [PDF]

				B. Zingone, E. Rauber, G. Gatti, A. Pappalardo, B. Benussi, G. Forti, U. Tognolli, and M. Gabrielli Diagnosis and management of severe atherosclerosis of the ascending aorta and aortic arch during cardiac surgery: focus on aortic replacement Eur. J. Cardiothorac. Surg., June 1, 2007; 31(6): 990 - 997. [Abstract] [Full Text] [PDF]

				B. Zingone, G. Gatti, E. Rauber, A. Pappalardo, B. Benussi, and L. Dreas Surgical Management of the Atherosclerotic Ascending Aorta: Is Endoaortic Balloon Occlusion Safe? Ann. Thorac. Surg., November 1, 2006; 82(5): 1709 - 1714. [Abstract] [Full Text] [PDF]

				C. Schreiber and R. Lange Porcelain aorta: therapeutical options for aortic valve replacement and concomitant coronary artery bypass grafting. Ann. Thorac. Surg., July 1, 2006; 82(1): 381 - 381. [Full Text] [PDF]