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Ann Thorac Surg 1995;60:76-77
© 1995 The Society of Thoracic Surgeons

Discussion

The first 20% of the full text of this article appears below.

	Introduction

 
See also page 67.

DR JOSEPH S. COSELLI (Houston, TX): Once again, Dr Kouchoukos' presentations and publications remain an ideal we all strive to achieve.

I thank Dr Kouchoukos for the opportunity to review the manuscript before the meeting. Doctor Kouchoukos and associates report on an experience with truly excellent results in a selective cohort of patients treated with an evolving strategy over a 9-year period. In this group of patients, however, I believe we need to make two clear distinctions, which Dr Kouchoukos has already pointed out.

One is the use of deep hypothermia and circulatory arrest in the left chest for aneurysms where, for technical or anatomic reasons, it is simply not possible to place a clamp for proximal control. These would include large aneurysms of the proximal descending thoracic aorta where no appropriate neck for proximal clamping is anatomically available.

The second is the extension of this modality for the purpose of spinal cord and visceral protection, particularly renal, in patients in whom cross-clamping proximally is possible. In my experience, it has been used relatively infrequently, for a total of 28 patients in whom circulatory arrest was used through the left chest out of 717 patients with either descending thoracic or thoracoabdominal aortic aneurysms. . . . [Full Text of this Article]