Recent Surgical Results of Transverse Aortic Arch Replacement / 日本心臓血管外科学会雑誌

ABSTRACT

We report the results of aortic arch replacement in 32 patients (20 males, 12 females) with aortic arch aneurysm, including 9 emergency cases. The etiology of aneurysm was atherosclerotic aneurysm in 18 patients, pseudoaneurysm in 1 patient, and aortic dissection in 13 patients. Selective cerebral perfusion (SCP) and retrograde cerebral perfusion (RCP), which are used for brain protection during aortic arch reconstruction, were both employed in this study according to our institutional policy. RCP was started at the moment of circulatory arrest after which the aneurysm was opened. In the case of 1-branch reconstruction or hemiarch replacement, we only employed RCP. If 2-branch reconstruction or total arch replacement was needed, we switched to SCP. After the distal graft anastomosis was performed, antegrade systemic perfusion was started via the 4th branch of the graft. Subsequently, 3 arch vessels was reconstructed with rewarming to shorten the SCP time, and finally proximal graft anastomosis was performed. Distal graft anastomosis with a new technique was applied in the 10 most recent cases. The “cuff” was made at the distal anastomosis site of the graft beforehand and this “cuff” was sutured to the aortic wall in an elephant-trunk fashion. This technique was a simple approach to repairing the distal lesion and allowed easy addition of stitches in case's of bleeding. The in-hospital mortality rate was 6.3% (2 of 32 patients) and the rate of cerebrovascular accident was 6.3% (2 of 32 patients). This technique for aortic arch repair is a useful method that results in low rates of in-hospital mortality and morbidity.