title: Aortic arch repairs through three different approaches.
abstract: OBJECTIVE
  The outcome of aortic arch repairs by means of three different approaches between 1990 and January 2000 was reviewed.
  
  
  METHODS
  In total 39 patients aged 71.5+/-6.2 years were operated on. The three different surgical approaches depended on the anatomical positions of the aneurysms and on their proximal or distal extension; a median approach was employed in 23 patients, whereas a left postero-lateral approach was used in eight patients. More recently, in eight cases a left antero-lateral approach was applied. All patients underwent open aortic anastomosis without any clamp on or around the aortic arch. During the procedure, the brain was protected by a combination of profound hypothermic circulatory arrest and several techniques of retrograde cerebral perfusion.
  
  
  RESULTS
  Permanent cerebral dysfunction occurred in four patients: two in the median approach and two in the left postero-lateral approach. There were two hospital deaths (5.3%) and six late deaths, all of which belonged either to the median group or to the postero-lateral group. The antero-lateral approach did not produce any cerebral dysfunction, early death, or late death.
  
  
  CONCLUSIONS
  The outcome of aortic arch repairs using profound hypothermic circulatory arrest and variable techniques of retrograde cerebral perfusion, by means of three different approaches, was satisfactory. Of the three approaches, the antero-lateral approach can be employed easily, whether aneurysms extend proximally or distally.
authors.affiliation: Department of Cardiovascular Surgery, National Cardiovascular Center, 5-7-1 Fujishirodai, Suita, 565-8565, Osaka, Japan.ogino@hsp.ncvc.go.jp
authors.forename: H
authors.initials: H
authors.lastname: Ogino
authors.forename: Y
authors.initials: Y
authors.lastname: Ueda
authors.forename: T
authors.initials: T
authors.lastname: Sugita
authors.forename: K
authors.initials: K
authors.lastname: Matsuyama
authors.forename: K
authors.initials: K
authors.lastname: Matsubayashi
authors.forename: T
authors.initials: T
authors.lastname: Nomoto
authors.forename: T
authors.initials: T
authors.lastname: Yoshioka
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical; D017545:Aortic Aneurysm, Thoracic / Q000401:mortality / Q000601:surgery*; D002545:Brain Ischemia / Q000209:etiology* / Q000401:mortality; D002315:Cardiopulmonary Bypass; D005260:Female; D005500:Follow-Up Studies; D006324:Heart Arrest, Induced; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology* / Q000401:mortality; D012189:Retrospective Studies; D015996:Survival Rate; D013908:Thoracotomy