We congratulate Dr Soukiasian et al1 for the encouraging results obtained with routine hypothermic circulatory arrest (HCA) in thoracic/thoracoabdominal aortic operations since 1994, but some aspects merit a brief comment.
Neurologic complications are a major issue. The authors show a trend toward decreased paraplegia rates and wider reattachment of intercostal arteries is also more likely with HCA. However, adjuncts such as cerebrospinal fluid drainage were not validated clinically until recently and might also influence results without HCA.2 Permanent/transient stroke rates were approximately double with HCA. The avoidance of distal arch cross-clamping is an obvious advantage, but retrograde femoral artery perfusion may be equally hazardous. Furthermore, the study refers to a wide spectrum of aortic diseases and HCA times range from 5 minutes, which seems an exceedingly short interval, to 59 minutes, which is not uniformly safe without adjunctive perfusion. Lower temperatures, and the possible use of sequential repair with resumption of upper body perfusion after completion of the proximal anastomosis are not specified.
Pocar M, Moneta A, Donatelli F. Hypothermic Circulatory Arrest for Thoracic Aortic Operations. Arch Surg. 2005;140(10):1009–1010. doi:10.1001/archsurg.140.10.1009-b