title: Early outcomes after aortic arch replacement by using the Y-graft technique.
abstract: BACKGROUND
  Aortic arch replacement remains among the most technically challenging cardiovascular operations, incurring considerable risk for perioperative death and stroke. The trifurcated graft technique, in which a double Y-graft is used to connect brachiocephalic branches to the main aortic graft, was recently developed to simplify arch reconstruction, reduce embolization, and minimize related cerebral ischemia. We examined early outcomes of aortic arch replacement performed by using single or double Y-graft variations of this technique.
  
  
  METHODS
  Between December 2006 and May 2009, the Y-graft technique was used to perform aortic arch replacement in 55 patients. Thirty-three patients had prior median sternotomy (60%), and 34 (62%) had ascending aortic dissection. Axillary cannulation was used in 52 patients (95%), and hypothermic circulatory arrest and antegrade cerebral perfusion were used in all patients. Median systemic and cerebral circulatory arrest times were 65 minutes and 0 minutes, respectively. A first-stage elephant trunk repair was performed in 46 patients (84%). Follow-up data were obtained for all patients.
  
  
  RESULTS
  There were no in-hospital deaths and one 30-day death (2%). Three patients (5%) had strokes, 1 of which was transient. Actuarial 1-year and 2-year survival rates were 80.0% ± 5.4% and 77.6% ± 5.7%, respectively. Thirty-one of the elephant trunk patients (67%) subsequently underwent second-stage completion procedures, 5 (16%) of them endovascular.
  
  
  CONCLUSIONS
  Early results of aortic arch replacement by the Y-graft technique compare favorably with those of traditional approaches. The technique enables effective delivery of antegrade cerebral perfusion during complex arch procedures and incurs only a low risk of neurologic sequelae.
authors.affiliation: Texas Heart Institute at St. Luke’s Episcopal Hospital, and the Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas, USA. slemaire@bcm.edu
authors.forename: Scott A
authors.initials: SA
authors.lastname: LeMaire
authors.forename: Matt D
authors.initials: MD
authors.lastname: Price
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Parenti
authors.forename: Michael L
authors.initials: ML
authors.lastname: Johnson
authors.forename: Alicia D
authors.initials: AD
authors.lastname: Lay
authors.forename: Ourania
authors.initials: O
authors.lastname: Preventza
authors.forename: Joseph
authors.initials: J
authors.lastname: Huh
authors.forename: Joseph S
authors.initials: JS
authors.lastname: Coselli
mesh_terms: D000784:Aortic Dissection / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011474:Prosthesis Design; D013997:Time Factors; D016896:Treatment Outcome