title: Arch-first technique via clamshell incision: successful surgical reoperation for aortic arch dissection.
abstract: We report a case of successful reoperation for aortic arch dissection with use of the "arch-first" technique in a patient who had Marfan syndrome. Extracorporeal circulation was initiated via right subclavian artery cannulation, and the chest was entered through a clamshell incision for the best exposure. When the patient was cooled to 18 degrees C, the perfusion was stopped. After the 1st aortic arch anastomosis to a 30-mm Dacron graft, cerebral perfusion was reestablished via the right subclavian artery. The aortic repair was then completed. The cerebral ischemic time was 18 minutes, the aortic cross-clamp time was 69 minutes, and the total extracorporeal circulation time was 334 minutes. The patient was discharged from the hospital on postoperative day 10 with no neurologic impairment. The arch-first technique shortens the duration of brain ischemia. When combined with a clamshell incision, the technique is particularly helpful for reoperation of the aortic arch and thoracic aorta.
authors.affiliation: Department of Cardiovascular Surgery, Institute of Cardiology, Istanbul University, Istanbul, Turkey. aozkara@superonline.com
authors.forename: Ahmet
authors.initials: A
authors.lastname: Ozkara
authors.forename: Gurkan
authors.initials: G
authors.lastname: Cetin
authors.forename: Murat
authors.initials: M
authors.lastname: Mert
authors.forename: Okan
authors.initials: O
authors.lastname: Akinci
authors.forename: Can Caglar
authors.initials: CC
authors.lastname: Erdem
authors.forename: Kaya
authors.initials: K
authors.lastname: Suzer
mesh_terms: D000328:Adult; D000784:Aortic Dissection / Q000150:complications / Q000601:surgery*; D001013:Aorta, Thoracic / Q000601:surgery; D001014:Aortic Aneurysm / Q000150:complications / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation; D002404:Catheterization / Q000379:methods; D005112:Extracorporeal Circulation; D006801:Humans; D008297:Male; D008382:Marfan Syndrome / Q000150:complications*; D011093:Polyethylene Terephthalates; D011138:Polytetrafluoroethylene; D012086:Reoperation; D013249:Sternum / Q000601:surgery; D013348:Subclavian Artery; D013908:Thoracotomy / Q000379:methods; D013997:Time Factors
chemical_list: D011093:Polyethylene Terephthalates; D011138:Polytetrafluoroethylene