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Troncone et al. Vessel Plus 2023;7:14 https://dx.doi.org/10.20517/2574-1209.2023.08 Page 13 of 15

outcome rates for reversible adverse outcomes compared to non-DHCA techniques[25]. In contrast,

Yoo et al. published a retrospective analysis of their single centre experience in DTA and TAAA repair
comparing their use of DHCA vs non-DHCA strategies[8]. They found an increased risk of post-operative
low cardiac output syndrome and prolonged ventilator support when DHCA was used. As mentioned
above, there can be a multitude of explanations for the discrepant nature of these observational studies, and
it is difficult to make overall judgments on surgical techniques based on them. Nevertheless, a review of the
literature reveals that, aside from Kouchoukos his surgical group, the use of DHCA for the routine repair of
DTAs/TAAAs is rare. Coselli and colleagues published the largest report on TAAA repair, spanning three
decades and including 3309 patients, providing valuable insight into modern surgical outcomes on this
difficult pathology[1]. Of these patients, only 48 required the use of DHCA, the majority of which were those
with Crawford I/II TAAAs. They found that DHCA was amongst independent predictors of adverse
outcomes including permanent renal failure and operative death, a result explained by the fact that their use
of DHCA was reserved to highly complex cases and may reflect selection bias and thus not generalizable to
the routine use of DHCA for DTA/TAAA repair. Differences in outcomes for these technically challenging
interventions and their associated massive physiologic impact, is more likely related other factors, both
patient and otherwise, rather than the method of repair[44].

SUMMARY
DHCA to facilitate DTA/TAAA repair is an established technique with favorable outcomes. It obviates the
need for proximal cross clamping of hostile distal aortic arches or proximal descending aneurysms; need for
fenestration of the aortic arch; and improved organ protection by reducing oxygen consumption. However,
this is countered by the potential adverse effects on the myocardial, cerebral, and pulmonary systems, along
with the increased coagulopathy. The use of DHCA remains a clinical decision guided by the experience
and preferences of the surgical team as well as the technical demands of the proposed surgery.

DECLARATIONS
Authors’ contributions
Contributed in the design, literature review, and writing of the manuscript: Troncone MJ, Hong JC

Availability of data and materials
Not applicable.

Financial support and sponsorship
None.

Conflicts of interest
All authors declared that there are no conflicts of interest.

Ethical approval and consent to participate
Not applicable.

Consent for publication
Not applicable.

Copyright
© The Author(s) 2023.