title: Contemporary results of total aortic arch replacement.
abstract: OBJECTIVE
  Aneurysmal dilatation of the aortic arch is uncommon, and the complex anatomy involved imposes unique technical challenges. The results of surgical intervention reported from large centers are improving; however, the degree to which these results are reproducible by other surgeons is less clear. We therefore reviewed our recent experience with total aortic arch replacement.
  
  
  METHODS
  Between July 1, 1997 and July 1, 2001 19 patients underwent complete aortic arch replacement, with or without concomitant procedures. We retrospectively reviewed perioperative results retrieved from the computerized database and clinical records.
  
  
  RESULTS
  The mean age of the study population was 68 +/- 8.3 years (range 52 to 82), with women predominating (11 women, 8 men). All patients had hypertension. Patient history indicated active or past tobacco abuse in 16 patients (80%); cerebrovascular disease in 3, and peripheral vascular disease in 7 patients. Associated procedures included an elephant trunk in 12 (63%), replacement of the upper descending thoracic aorta in 5 (26%), concomitant coronary artery bypass in 5 (26%), and aortic root replacement in 3 (16%). One patient underwent replacement of the entire aorta from sinotubular ridge to iliac bifurcation in a single procedure. Brachiocephalic reconstruction with a "Y-graft" permitting early antegrade cerebral perfusion was performed in 12 patients. Retrograde cerebral perfusion was performed in ten patients (53%). Perioperatively, death occurred in two patients (11%) and stroke in two (11%).
  
  
  CONCLUSIONS
  With cautious application, techniques developed in high-volume centers can also achieve satisfactory results when used at centers with a more modest case volume.
authors.affiliation: Department of Surgery, Washington University School of Medicine, St Louis, Missouri, USA. sundt.thoralf@mayo.edu
authors.forename: Thoralf M
authors.initials: TM
authors.lastname: Sundt
authors.forename: Marc R
authors.initials: MR
authors.lastname: Moon
authors.forename: Nilto
authors.initials: N
authors.lastname: DeOliviera
authors.forename: Jerome
authors.initials: J
authors.lastname: McDonald
authors.forename: Cynthia J
authors.initials: CJ
authors.lastname: Camillo
authors.forename: Michael K
authors.initials: MK
authors.lastname: Pasque
mesh_terms: D000368:Aged; D000784:Aortic Dissection / Q000601:surgery; D001013:Aorta, Thoracic / Q000473:pathology / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000601:surgery; D001019:Aortic Rupture / Q000601:surgery; D006348:Cardiac Surgical Procedures; D004108:Dilatation, Pathologic / Q000601:surgery; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D008923:Missouri; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome