Whether or not a surgeon uses DHCA (and how skilled they are with it) is something that is very important to know.
If the aortic arch is involved, DHCA is required because there must be a way to work on the part of the aorta that supplies blood to the brain. Aortic arch surgery is very difficult, and generally fewer surgeons do this surgery.
For the ascending aorta, some do use DHCA, but many do not. It is a simpler technique to just cross clamp the aorta near the arch. But that leaves some of the ascending aorta behind.
For my own ascending aorta, I would want to find someone highly skilled in DHCA. I would want to know that my entire ascending aorta is removed, and if there is any involvement at all with my aortic arch - sometimes the "underside" of the arch tissue may be affected - I want to know that this will all be taken care of.
I would want just one surgery on this part of my aorta. I do not want to wonder if there could be problems with aortic tissue that was "left behind" later. As ks1490 is doing, the challenge is in searching to find the surgical skill to do this well.
Aortic surgeons will know their DHCA statistics and outcomes, which they watch very closely. They will discuss their typical DHCA times with their patients. This is the time in minutes when the heart lung machine is "off", brain wave activity is 0 as measured by EEG, and the aorta is open, not clamped. This is what allows them to remove ALL of the ascending aorta.
Surgeons may debate whether or not they really need to do DHCA when working on the ascending aorta. While they are debating, for myself I would want someone with the skill to do what was done for my husband. He had DHCA for 23 minutes, and experienced no neurological consequences at all. He also has never been affected by the heart lung machine, although some people are.
My husband is already complex enough. I am glad that we do not have to wonder about any ascending aortic tissue - because none was left behind. A small amount of tissue underneath his arch was replaced with Dacron also. Only time will tell how the rest of his aorta may stand up, but we do know that the ascending aorta was dealt with completely 5 years ago.
For anyone wanting to do research in the medical literature, this paper from 1975 will give you an indication on where DHCA has evolved from, with these 4 patients' surgery on their aortic arch.
http://www.ncbi.nlm.nih.gov/entrez/...ed&dopt=Abstract&list_uids=1186283&query_hl=1
Dr. Griepp and his work with DHCA at Mt. Sinai in NY is well documented in the medical literature over many years.
Best wishes,
Arlyss
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