title: Total aortic arch aneurysm repair using a stent graft without cardiac or cerebral ischemia.
abstract: A 74-year-old man with an aortic arch aneurysm and a chronic type IIIb aortic dissection underwent total aortic arch repair without cerebral or cardiac ischemia. After confirming no atheromatous change in the ascending aortic wall, a custom-designed 4-limbed graft, prepared for both arterial return of cardiopulmonary bypass and reconstruction of the arch vessels, was anastomosed onto the right side of the ascending aorta. The 3 arch vessels were then bypassed sequentially during systemic cooling and monitoring cerebral perfusion with near-infrared oxymetry. After aortic cross-clamping, a stent graft was inserted into the distal arch from the distal ascending aorta, maintaining cerebral and cardiac perfusion. This procedure is indicated especially in a high-risk patient who has an aortic arch aneurysm without severe atheromatous change in the ascending aorta and the arch vessels.
authors.affiliation: Department of Cardiothoracic Surgery, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan.
authors.forename: Junichi
authors.initials: J
authors.lastname: Naganuma
authors.forename: Mikio
authors.initials: M
authors.lastname: Ninomiya
authors.forename: Takeshi
authors.initials: T
authors.lastname: Miyairi
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Kotsuka
authors.forename: Shinichi
authors.initials: S
authors.lastname: Takamoto
mesh_terms: D000368:Aged; D000784:Aortic Dissection / Q000601:surgery*; D001011:Aorta / Q000601:surgery; D017545:Aortic Aneurysm, Thoracic / Q000601:surgery*; D006348:Cardiac Surgical Procedures / Q000379:methods*; D002315:Cardiopulmonary Bypass; D006801:Humans; D008297:Male; D019265:Spectroscopy, Near-Infrared; D015607:Stents; D014654:Vascular Patency; D014656:Vascular Surgical Procedures / Q000379:methods