We're unable to sign you in at this time. Please try again in a few minutes.
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Correspondence and Brief Communications |

Hypothermic Circulatory Arrest for Thoracic Aortic Operations

Marco Pocar, MD, PhD; Andrea Moneta, MD; Francesco Donatelli, MD
Arch Surg. 2005;140(10):1009-1010. doi:10.1001/archsurg.140.10.1009-b.
Text Size: A A A
Published online


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.

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal

First Page Preview

View Large
First page PDF preview





Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
Submit a Comment


Some tools below are only available to our subscribers or users with an online account.

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal

Related Content

Customize your page view by dragging & repositioning the boxes below.

See Also...
Articles Related By Topic
Related Collections
PubMed Articles

The Rational Clinical Examination: Evidence-Based Clinical Diagnosis
Original Article: Does This Patient Have Abdominal Aortic Aneurysm?

The Rational Clinical Examination: Evidence-Based Clinical Diagnosis
Original Article: Does This Patient Have an Acute Thoracic Aortic Dissection?