title: [Partial or total replacement of the aortic arch. Experience in 23 patients].
abstract: BACKGROUND
  Surgery of the aortic arch is a very complex procedure since it requires protective strategies for the brain, heart and rest of the body.
  
  
  OBJECTIVE
  To communicate our experience in the first 23 total or partial replacements of aortic arch.
  
  
  METHODS
  Retrospective search in the database of the Cardiovascular Surgery Unit for patients subjected to partial or total replacement of the aortic arch since 1998.
  
  
  RESULTS
  Between 1988 and 2002, 23 patients were operated. Seventeen had aortic dissection (10 acute and 7 chronic), five had an atherosclerotic aneurysm and one had a traumatic lesion. Thirteen patients were subjected to a replacement of the arch plus ascending aorta, six to a replacement of the arch plus descending aorta and four to a replacement of the arch, ascending and descending aorta. Seven patients had previous operation of the thoracic aorta. Arterial perfusion was done via the femoral artery, axillary artery or a combination of both. A hypothermic circulatory arrest was induced in 22; it was associated with cerebral retro perfusion alone in 8 patients, antegrade cerebral perfusion in 5; isolated or associated axillary perfusion was used in five patients. In seven, procedures on the aortic or mitral valve, or coronary artery operations were added. Operative mortality was 26%, 3 of the 8 patients operated as an emergency and 3 of 15 elective operations. There was no mortality among those without dissection and of 7 chronic dissections, one died. All patients were followed for an average of 45 months. Two patients required reinterventions on the aorta and one for colon cancer. There was one late death of unknown cause. Postoperative complications were agitation, bleeding and temporary vocal cord dysfunction.
  
  
  CONCLUSIONS
  There is a learning curve, where more extensive operations, particularly those done as emergency or for dissections, had an increased operative risk.
authors.affiliation: Departamentos de Enfermedades Cardiovasculares, Facultad de Medicina, Pontificia Universidad Católica de Chile. manuelj@med.puc.cl
authors.forename: Manuel J
authors.initials: MJ
authors.lastname: Irarrázaval Ll
authors.forename: Sergio
authors.initials: S
authors.lastname: Morán V
authors.forename: Ricardo
authors.initials: R
authors.lastname: Zalaquett S
authors.forename: Pedro
authors.initials: P
authors.lastname: Becker R
authors.forename: Cristian
authors.initials: C
authors.lastname: Baeza P
authors.forename: Jorge
authors.initials: J
authors.lastname: Urzúa U
authors.forename: Guillermo
authors.initials: G
authors.lastname: Lema F
authors.forename: Roberto
authors.initials: R
authors.lastname: Canessa B
authors.forename: Gastón
authors.initials: G
authors.lastname: Chamorro S
authors.forename: Sandra
authors.initials: S
authors.lastname: Braun J
authors.forename: Samuel
authors.initials: S
authors.lastname: Córdova A
authors.forename: Bernardita
authors.initials: B
authors.lastname: Garayar P
mesh_terms: D000784:Aortic Dissection / Q000401:mortality / Q000601:surgery*; D001013:Aorta, Thoracic / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000401:mortality / Q000601:surgery*; D001921:Brain / Q000098:blood supply; D050792:Circulatory Arrest, Deep Hypothermia Induced; D005112:Extracorporeal Circulation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome