Bayard Gontijo FilhoI; Fernando Antônio FantiniI; Juscelino Teixeira BarbosaI; João Alfredo de Paula e SilvaI; Marcelo Frederique de Castro; Eduardo O. A Peredo; Adelso A Pedrosa; Flavio Donizete Gonçalves; Mário Osvaldo VrandecicI
DOI: 10.1590/S0102-76381991000100003
ABSTRACT
The authors report 14 cases of aneurysms and/or dissections of the thoracic aorta, treated with deep hypothermia and circulatory arrest. There were 6 aneurysms of the aorta (1 of the ascending aorta, 3 of the aortic arch, 1 of the ascending aorta and aortic arch, 1 of the descending aorta) and 8 cases of aortic dissections. The patients were gradually colled down to 18ºC of nasopharingeal temperature. The mean circulatory arrest time was 35 minutes. There were 4 hospital deaths; 1 patient died in the operating room, from persistent surgical bleeding; 1 patient died from acute renal failure, which was already present in the pre-operative period; 1 patient died after an acute myocardial infarction followed by ventricular fibrillation; 1 patient died from pulmonary infection following a carebro-vascular accident. This was the only death directly related to the circulatory arrest technique. Among the 10 survivors, there were 2 patients who required prolonged ventilatory support and 4 minor neurological abnormalities with complete recovery. The technique of deep hypothermia and circulatory arrest proved to be a good alternative in the treatment of difficult aortic lesions.RESUMO
São apresentados 14 casos de aneurismas e/ou dissecções da aorta torácica submetidos a correção cirúrgica com o emprego de hipotermia profunda e parada circulatória. Entre os 14 pacientes, seis eram portadores de aneurismas da aorta (um de aorta ascendente, três do arco aórtico, um de aorta ascendente + arco aórtico, um de aorta descendente) e oito eram portadores de dissecção aórtica. A hipotermia foi induzida gradualmente até atingir 18ºC de temperatura nasofaríngea. O período médio de parada circulatória foi de 35 minutos. Houve quatro óbitos hospitalares, sendo um por problemas hemorrágicos, um por arritmia ventricular pós IAM, um por insuficiência renal aguda já existente no pré-operatório e um por AVC e infecção pulmonar secundária. Dos 10 pacientes, dois apresentaram insuficiência respiratória com assistência ventilatória prolongada e quatro apresentaram distúrbios neurológicos transitórios, com recuperação total. A técnica de hipotermia profunda e parada circulatória mostrou-se como boa alternativa na abordagem cirúrgica de lesões graves da aorta torácica.REFERENCES
1. ANTUNES, M. J.; COLSEN, P. R.; KINSLEY, R. H. - Hypothermia and circulatory arrest for surgical resection of aortic arch aneurysms. H. Thorac. Cardiovasc. Surg., 86: 576-581, 1983.
2. CONNOLY, J. E.; ROY, A.; GUERNSEY, J. M.; STERMMER, E. A. - Bloodless surgery by means of profound hypothermia and circulatory arrest: effect of brain and heart. Ann. Thorac. Surg., 162: 724-737, 1965.
3. CRAWFORD, E. A.; SVENSSON, L. G.; CONSELLI, J. S.; SAFI, H. J.; HESS, K. R. - Surgical treatment of aneurysm and/or dissection of the ascending aorta, transverse aortic arch and transverse aortic arch: factors influencing survival in 717 patients. J. Thorac. Cardiovasc. Surg., 98: 659-674, 1989.
4. CREEPS Jr., J. T.; ALLMENDINGER, P.; ELLISON, L.; HUMPHREY, C.; PREISLLER, P.; LOW, H. - Hypothermia circulatory arrest in the treatment of thoracic aortic lesions. Ann. Thorac. Surg., 43: 644-647, 1987. [MedLine]
5. ERGIN, M. A.; O'CONNOR, J.; GUINTO, R.; GRIEPP, R. A. - Experience with profound hypothermia and circulatory arrest in the treatment of aneurysms of the aortic arch: aortic arch replacement for acute arch dissections. J. Thorac. Cardiovasc. Surg., 84: 649-655, 1982. [MedLine]
6. FRIST, W. H.; BALDWIN, J. C.; STARNES, V. A.; STINSON, E. B.; OYER, P. E.; MILLER, C.; JAMIESON, S. W.; MITCHELL, R. S.; SHUMWAY, N. E. - A reconsideration of cerebral perfusion in aortic arch replacement. Ann. Thorac. Surg., 42: 273-281, 1986. [MedLine]
7. GRIEPP, R. B.; STINSON, E. B.; HOLLINSGSWORTH, J. F.; BUCHLER, D. - Prosthetic replacement of the aortic arch. J. Thorac. Cardiovasc. Surg., 70: 1055-1063, 1975.
8. KIRKLIN, J. N.; & BARRATT-BOYES, B. G. - Cardiac Surgery. New York, John Willey and Sons, 1986. p. 41.
9. LANSMAN, S. L.; RAISSI, S.; ERGIN, M. A.; GRIEPP, R. B. - Urgent operation for acute transverse aortic arch dissection. J. Thorac. Cardiovasc. Surg., 97: 334-341, 1989. [MedLine]
10. LIVESAY, J. J.; COOLEY, D. A.; REUL, G. T.; WALKER, W. E.; FRAZIER, O. H.; DUNCAN, J. M.; OTT, D. A. - Ressection of aortic arch aneurysms: a comparison of hypothermia techniques in 60 patients. Ann. Thorac. Surg., 36: 19-28, 1983.
11. MAHFOOF, S.; QAZI, A.; GARCIA, J.; MISPIRETA, L.; CORSO, P.; SMYTH, N. - Management of aortic arch aneurysms using profound hypothermia and circulatory arrest. Ann. Thorac. Surg., 39: 412-417, 1985. [MedLine]
12. SWEENEY, M. S.; COOLEY, D. A.; REUL, G. T.; OTT, D. A.; DUNCAN, J. M. - Hypothermic circulatory arrest for cardiovascular lesions: technical considerations and results. Ann. Thorac. Surg., 40: 498-503, 1985. [MedLine]