title: Total replacement of the ascending aorta without circulatory arrest.
abstract: OBJECTIVE
  If the aortic arch is clamped between the brachiocephalic trunk and the left common carotid artery and the brachiocephalic trunk is also clamped, the total ascending aorta can be replaced without circulatory arrest. Candidates for this technique need to have the following characteristics: preoperative demonstration of Willis polygon patency by means of transcranial Doppler ultrasonography, preoperative computed tomographic scan that shows no calcification in the arch or in the brachiocephalic trunk, and preoperative or intraoperative evidence of separate origins of the brachiocephalic trunk and the left common carotid artery.
  
  
  METHODS
  In three different institutions (with different time frames in each) from December 2000 to December 2001, the possibility of replacing the total ascending aorta without circulatory arrest was evaluated in 14 cases. In 10 of them it was possible (feasibility of 71.4%). During the procedure continuous electroencephalographic monitoring was performed.
  
  
  RESULTS
  No patient died in the early or midterm follow-up. None of the patients had any cerebral complications. The electroencephalographic activity was normal during the period of brachiocephalic trunk occlusion. In 5 patients a postoperative spiral computed tomographic scan showed good surgical results.
  
  
  CONCLUSIONS
  The technique described here allows replacement of the total ascending aorta without circulatory arrest in selected cases. Furthermore, the evidence of lack of right cerebral hypoperfusion in all the procedures we performed allows future exploration of the possibility of avoiding cerebral monitoring.
authors.affiliation: Departments of Cardiac Surgery and Cardiology, G. D'Annunzio University, Chieti, Italy.
authors.forename: Marcio
authors.initials: M
authors.lastname: Scorsin
authors.forename: Nawwar
authors.initials: N
authors.lastname: Al-Attar
authors.forename: Marco
authors.initials: M
authors.lastname: Scarci
authors.forename: Michele
authors.initials: M
authors.lastname: Di Mauro
authors.forename: Richard
authors.initials: R
authors.lastname: Raffaul
authors.forename: Arrigo
authors.initials: A
authors.lastname: Lessana
authors.forename: Antonio Maria
authors.initials: AM
authors.lastname: Calafiore
mesh_terms: D001011:Aorta / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation; D004569:Electroencephalography; D005260:Female; D006324:Heart Arrest, Induced; D006801:Humans; D008297:Male; D008875:Middle Aged; D018579:Patient Selection