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J Thorac Cardiovasc Surg 2002;123:621-623
© 2002 The American Association for Thoracic Surgery

Editorials

Temperature management after hypothermic circulatory arrest

From the Division of Cardiothoracic Surgery, Baylor College of5 Medicine and The Methodist DeBakey Heart Center, Houston, Tex.

Received for publication Dec 27, 2001. Accepted for publication Jan 9, 2002. Address for reprints: Joseph S. Coselli, MD, 6560 Fannin St, Suite 1100, Houston, TX 77030 (E-mail: jcoselli@bcm.tmc.edu).

	Introduction

 
See related article on page 422.

Cerebral protection during the surgical treatment of complex aortic disease, primarily involving the transverse aortic arch, continues to be a major clinical challenge for cardiac surgeons. Profound hypothermic circulatory arrest (HCA) remains a mainstay for brain protection during such operations because it is simple and has been efficacious in broad clinical use. However, despite its extensive use and inherent simplicity, HCA has important limitations. Most notably, the protective effect of profound hypothermia decreases as the circulatory arrest time increases. In a review of a series of 656 patients undergoing aortic surgery with HCA reported by Svensson and associates, ¹ the stroke and mortality rates increased significantly after 40 minutes and 65 minutes of HCA, respectively.

Considerable difference of opinion exists as to how to overcome the inherent time constraints of HCA. Although most of the debates center on the selection of different perfusion techniques (ie, retrograde and antegrade cerebral perfusion) and potential pharmacologic adjuncts, the ideal temperature management strategy also remains unresolved. Whereas previous reports have focused on temperature management before and during HCA, ^2-5 recent studies have given more attention to post-HCA temperature management, especially during the rewarming phase. ^6,7

	Postoperative hypothermia: A new area of investigation

 
In this issue of the Journal, Romsi and his coworkers ⁸ have extended the study of temperature management beyond the operating room by evaluating prolonged postoperative mild hypothermia in a porcine HCA model. After 75 minutes of HCA, 10 pigs underwent immediate rewarming to 37°C while 10 others were rewarmed to only 32°C . . . [Full Text of this Article]

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