title: Arch-first technique for aortic arch operation using branched graft.
abstract: To compare the arch-first technique with conventional aortic arch reconstruction 19 patients were randomly assigned to either procedure. Nine patients underwent the arch-first technique (group A) and 10 underwent the conventional technique (group B). There were no hospital deaths and no significant differences between groups in terms of intraoperative bleeding or the duration of operation cardiopulmonary bypass aortic crossclamping recovery from anesthesia or intensive care. The mean duration of retrograde cerebral perfusion via the superior vena cava was significantly shorter in group A (41.7 +/- 10.4 min) than group B (63.9 +/- 10 min). Transient neurologic dysfunction was noted in 4 (44%) patients in group A 6 (60%) in group B postoperatively but there was no permanent neurologic dysfunction in either group. The arch-first technique makes it possible to reduce the duration of cerebral ischemia retrograde cerebral perfusion via the superior vena cava reestablish antegrade cerebral perfusion earlier without damaging severely atheromatous arch vessels or conducting retrograde cerebral perfusion via a femoral artery. This technique has the potential to reduce the incidence of neurologic dysfunction.
authors.affiliation: Department of Cardiovascular Surgery, The Heart Institute of Japan, Tokyo Women's Medical University, 8-1 Kawada, Shinjuku, Tokyo 162-8666, Japan. htsukui@jasmine.ocn.ne.jp
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Tsukui
authors.forename: Shigeyuki
authors.initials: S
authors.lastname: Aomi
authors.forename: Hideyuki
authors.initials: H
authors.lastname: Tomioka
authors.forename: Masaki
authors.initials: M
authors.lastname: Nonoyama
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Koyanagi
authors.forename: Chinami
authors.initials: C
authors.lastname: Nagasawa
authors.forename: Minoru
authors.initials: M
authors.lastname: Nomura
mesh_terms: D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical / Q000009:adverse effects / Q000379:methods; D001013:Aorta, Thoracic / Q000601:surgery*; D001018:Aortic Diseases / Q000401:mortality / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects* / Q000379:methods*; D013504:Cardiovascular Surgical Procedures / Q000009:adverse effects* / Q000379:methods*; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009422:Nervous System Diseases / Q000209:etiology* / Q000517:prevention & control*; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications; D015996:Survival Rate