Perfusion techniques of profound hypothermia and circulatory arrest for pulmonary thromboendarterectomy

One hundred ninety-five patients with the diagnosis of chronic pulmonary thromboembolic pulmonary hypertension have been operated on utilizing a standardized protocol involving profound hypothermia and circulatory arrest. A small subgroup, nine, were identified preoperatively as having heparin-associated thrombocytopenia (HAT). This challenging subgroup of patients was treated during heparin exposure with an investigational, ''platelet disaggregating'' agent, Iloprost. The surgical procedure of pulmonary thromboendarterectomy requires multiple periods of circulatory arrest under profound hypothermia. Perfusion management of this procedure involves cerebral and myocardial protection, cooling, reperfusion at hypothermia, and rewarming; treatment with Iloprost when appropriate; and methods of hemodilution.

Duke Scholars

Author William R. Auger Medicine, Pulmonary, Allergy, and Critical Care Medicine