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Troncone et al. Vessel Plus 2023;7:14 Vessel Plus
DOI: 10.20517/2574-1209.2023.08

Review Open Access

Descending thoracic and thoracoabdominal aortic

aneurysm repair using deep hypothermic circulatory
arrest

Michael J. Troncone, Jonathan C. Hong

St. Boniface Hospital, Section of Cardiac Surgery, Department of Surgery, Max Rady College of Medicine, University of Manitoba,
Winnipeg R2H 2A6, Canada.
Correspondence to: Dr. Jonathan Hong, St. Boniface Hospital, Section of Cardiac Surgery, Department of Surgery Max Rady
College of Medicine, University of Manitoba, 369 Tache Ave, Winnipeg R2H 2A6, Canada. E-mail: Jhong2@sbgh.mb.ca
How to cite this article: Troncone MJ, Hong JC. Descending thoracic and thoracoabdominal aortic aneurysm repair using deep
hypothermic circulatory arrest. Vessel Plus 2023;7:14. https://dx.doi.org/10.20517/2574-1209.2023.08

Received: 20 Feb 2023 First Decision: 30 May 2023 Revised: 25 Jun 2023 Accepted: 30 Jun 2023 Published: 20 Jul 2023
Academic Editor: Frank W. Sellke Copy Editor: Dan Zhang Production Editor: Dan Zhang

Abstract
Descending thoracic and thoracoabdominal aortic replacement is a complex and high-risk surgery. Deep
hypothermic circulatory arrest (DHCA) is a surgical technique that is useful in large distal aortic arch aneurysms or
chronic dissections that require fenestration where proximal cross clamping would be difficult. It can also be used
as part of a multimodal strategy for end-organ protection. However, DHCA has potential adverse effects on the
myocardial, cerebral, pulmonary, and coagulation systems. The use of DHCA is guided by the experience and
preferences of the surgical team as well as the technical demands of the proposed surgery.

Keywords: Descending thoracic, deep hypothermic circulatory arrest, thoracoabdominal aortic surgery

INTRODUCTION
Descending thoracic (DTA) and thoracoabdominal aortic (TAAA) replacement is a complex and high-risk
surgery. Extensive anatomic exposure is required; necessitating a thoracotomy or a thoraco-phreno-
laparotomy which can lead to pulmonary complications, diaphragmatic dysfunction, as well as
[1]
compromised wound healing . Organ dysfunction is common and is due to a combination of potential
atheroembolic events, ischemic-reperfusion injury, and hemodynamic changes during aortic cross-
clamping . Despite multimodal advances in intraoperative and postoperative care, rates of both mortality
[2]

© The Author(s) 2023. Open Access This article is licensed under a Creative Commons Attribution 4.0
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