Circulatory Arrest or Cerebral Perfusion During Pulmonary Endarterectomy?

Pulmonary endarterectomy for chronic thromboembolic pulmonary hypertension (CTEPH) requires a totally bloodless surgical field to define the dissection plane in the thin pulmonary artery. This is generally achieved by deep hypothermic circulatory arrest (DHCA); however, some experts propose that maintaining antegrade cerebral perfusion (ACP) might reduce the risk for cognitive impairment after DHCA. To find out more, investigators in the U.K. randomized 74 severely symptomatic adults with CTEPH (mean age, 52; mean body-mass index, 30; women, 50%) to undergo pulmonary endarterectomy with either ACP or DHCA for up to 20 minutes. Nine patients in the ACP group had to cross over to DHCA to enable complete endarterectomy.

At 12 weeks, the three m…