Combined Hypothermic Circulatory Arrest and Warm Blood Cardioplegia for Aortic Surgery

This is a case of an 87 -year-old male who underwent successful repair of an acute ascending aortic dissection (Stanford Type A). Hypothermic circulatory arrest was used to provide cerebral protection during the performance of the "open" distal anastomosis. Continuous normothermic retrograde blood cardioplegia was used as a means for myocardial protection. To our knowledge, this is the first report of combining warm (aerobic) cardiac preservation with hypothermic circulatory arrest. We describe the perfusion management and discuss the rationale for the use of normothermic blood cardioplegia. We advocate the use of warm aerobic myocardial arrest for all procedures requiring myocardial protection regardless of systemic temperature. Address correspondence to: David B. DiMarco, MD 4221 Penn AvenueSuite G-1 03 Pittsburgh, PA 15224 Volume 25, Number 3, 1993 105 THE jOURNAL OF EXTRA-CORPOREAL TECHNOLOGY INTRODUCTION Table 1 Ascending, transverse and some descending aortic aneurysms and dissections frequently require arrest Components of Crystalloid Cardioplegia (mixed 1 :4 with blood) High Potassium Low Potassium of the circulation to adequately repair or replace diseased segments. This provides excellent exposure, can avoid clamping of a diseased aorta and in general, greatly facilitates aortic surgery. Deep hypothermia was develDextrose 50% 30ml Dextrose 50% 30 ml KCI 128 mEq KCI 25 mEq NaHC0 3 7.5% 75 ml NaHC0 3 7.5% 75ml oped as a means of cerebral protection during circulatory Plasma-Lyte A 1000 ml Plasma-Lyte A 1000 ml arrest. (1) Cerebral protection, along with other organ preservation, has been shown to be excellent (within time constraints) with this technique. (2) In the past, hypothermia, with or without cardioplegic infusions, has been the mainstay of myocardial protection. Normothermic continuous retrograde blood cardioplegia has recently been added in an attempt to improve myocardial protection during cardiac procedures. This case report describes the use of warm aerobic myocardial arrest combined with systemic hypothermic circulatory arrest.