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J Thorac Cardiovasc Surg 2004;127:1256-1261
© 2004 The American Association for Thoracic Surgery

Editorial

The Boston Circulatory Arrest Study: An analysis

Ross M. Ungerleider, MDa,b,*, J. William Gaynor, MDc

a Division of Cardiothoracic Surgery, Oregon Health & Science University, Portland, Ore, USA
b Department of Pediatric Cardiac Surgery, Doernbecher Children's Hospital, Portland, Ore, USA,
c Children's Hospital of Philadelphia, Philadelphia, Pa, USA

Received for publication December 22, 2003; revisions received December 31, 2003; accepted for publication January 27, 2004.

* Address for reprints: Ross M. Ungerleider, MD, Doernbecher Children's Hospital, Pediatric Cardiac Surgery Section, Oregon Health Science University, 3181 SW Sam Jackson Park Rd, DC8S, Portland, OR 97201-3098, USA
ungerlei@ohsu.edu

The first 300 words of the full text of this article appear below.


See related articles in J Thorac Cardiovasc Surg. 2003;126:1385-96 and 2003;126:1397-403.

 

In their two articles published in the November issue of the Journal,1,2 the group from the Children's Hospital in Boston have provided us with the best clinical data available comparing deep hypothermic circulatory arrest (DHCA) with hypothermic, continuous low-flow bypass (LF)—2 cardiopulmonary bypass (CPB) strategies that are commonly used during the repair of congenital heart defects in infants.

It is relevant to provide a brief historical perspective regarding how and why these studies were designed. DHCA became popular after its use was reported by Kirklin and associates3 in 1961 and later in neonates and infants by Barratt-Boyes and associates in 19704 because it greatly simplified cardiac repair in infants in an era that did not have the sophisticated CPB technology (including thin-walled cannulas with excellent flow characteristics, smaller circuits with membrane oxygenators, and much more) that we enjoy today. By using DHCA, surgeons could repair intracardiac defects in a bloodless field unencumbered by cannulas. Furthermore, surgeons avoided many of the complications created by the more primitive CPB systems, and this most likely produced success in an era when prolonged exposure to CPB was very likely detrimental. Results were generally favorable, and the use of DHCA made cardiac repair in infants reproducibly possible. As technology improved and surgeons began to tackle repair of more complex lesions, DHCA became a staple in the armamentarium of cardiac surgeons. Its use became so ingrained in the practice patterns of cardiac surgeons that it was unusual in the 1980s to find successful pediatric cardiac centers anywhere in the world that did not use DHCA on a routine basis.

By the late 1980s, the seeds of concern were germinating regarding the effect of DHCA on the neurologic development of the infants exposed to . . . [Full Text of this Article]


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