title: [Distal aortic repair after aortic arch replacement].
abstract: BACKGROUND
  It is crucial to expose the proximal aorta in distal aortic repair, i.e., replacement of the descending thoracic aorta (DTA) or the thoracoabdominal aorta (TAA), after aortic arch replacement. With the elephant trunk (ET), it is usually easy to expose and clamp it. On the other hand, without the ET, it may be difficult or impossible to expose the proximal aorta and deep hypothermic circulatory arrest (DHCA) will be required.
  
  
  METHODS
  Between April 1989 and March 2007, 17 patients underwent distal aortic repair after aortic arch replacement. Five patients underwent replacement of DTA and 12 of TAA. Five patients without the ET needed DHCA and open proximal anastomosis [OP (+) group], while in 12 patients, the ET or proximal aorta was successfully clamped [OP (-) group].
  
  
  RESULTS
  The mean extracorporeal circulation time in OP (+) group was significantly longer than that in OP (-) group (415 +/- 131 min v.s. 267 +/- 109 min, p < 0.05). There was no hospital death, cerebral infarction, fatal arrhythmia or low output syndrome in either group, and paraplegia in 2 patients and renal failure requiring hemodialysis in one were found only in OP (+) group.
  
  
  CONCLUSIONS
  The ET procedure enables to avoid DHCA and may contribute to improving operative results in distal aortic repair after aortic arch replacement.
authors.affiliation: Department of Cardiovascular Surgery, Graduate School of Medicine, Tohoku University, Sendai, Japan.
authors.forename: Makoto
authors.initials: M
authors.lastname: Kamada
authors.forename: Yoshikatsu
authors.initials: Y
authors.lastname: Saiki
authors.forename: Katsuhiko
authors.initials: K
authors.lastname: Oda
authors.forename: Junetsu
authors.initials: J
authors.lastname: Akasaka
authors.forename: Yoshio
authors.initials: Y
authors.lastname: Nitta
authors.forename: Shunsuke
authors.initials: S
authors.lastname: Kawamoto
authors.forename: Naotaka
authors.initials: N
authors.lastname: Motoyoshi
authors.forename: Koichi
authors.initials: K
authors.lastname: Tabayashi
mesh_terms: D000784:Aortic Dissection / Q000601:surgery*; D001012:Aorta, Abdominal / Q000601:surgery*; D001013:Aorta, Thoracic / Q000601:surgery*; D001014:Aortic Aneurysm / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D014656:Vascular Surgical Procedures / Q000379:methods*