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J Thorac Cardiovasc Surg 2007;134:1069-1070
© 2007 The American Association for Thoracic Surgery

Brief Communication

Fatal intraoperative thrombosis in contemporary adult thoracic aortic surgery requiring deep hypothermic circulatory arrest: Observations from the literature, 1993–2006

Cardiothoracic Section, Anesthesiology and Critical Care, Philadelphia, Pa.

Received for publication May 22, 2007; accepted for publication May 30, 2007.

^_* Address for reprints: John G. T. Augoustides, MD, FASE, Cardiothoracic Section, Anesthesiology and Critical Care, Dulles 680, HUP, 3400 Spruce St, Philadelphia, PA 19104-4283. (Email: yiandoc@hotmail.com).

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Fatal intravascular coagulation in the setting of thoracic aortic surgery with deep hypothermic circulatory arrest (DHCA) was highlighted in a case series (n = 20) that identified exposure to aprotinin as a significant risk factor.¹ The findings in this case series have since been attributed to inadequate heparinization because it was only appreciated thereafter that aprotinin prolongs the celite-based activated clotting time (ACT).² However, even in the presence of adequate heparinization by kaolin-based ACT or heparin concentration, case reports of fatal thrombosis in thoracic aortic surgery with DHCA have persisted (n = 5, 1998–2006).^2–5 The purpose of this brief communication is to review this case series as a platform from which further research can be planned. . . . [Full Text of this Article]

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