title: Outcomes of total arch replacement with stepwise distal anastomosis technique and modified perfusion strategy.
abstract: OBJECTIVE
  Total arch replacement has been reported to present high morbidity and mortality. We have introduced a stepwise distal anastomosis technique and modified perfusion strategy, including selective antegrade cerebral perfusion, moderate hypothermia, and separate lower-body perfusion, to minimize organ ischemia and secondary morbidities. We report the operative outcomes of total arch replacement with our modified perfusion strategy.
  
  
  METHODS
  Between August 2006 and December 2008, 119 patients underwent total arch replacement with the current perfusion strategy. Of these patients, 56 (47%) underwent emergency operation for acute type A aortic dissection (n = 48) or ruptured thoracic aneurysm (n = 8). The mean age of patients was 68 years, and the mean follow-up period was 25 months. We analyzed operative mortality, morbidity, and 4-year survival of this patient group.
  
  
  RESULTS
  The mean operation, cardiopulmonary bypass, and circulatory arrest times were 313, 183, and 47 minutes, respectively. Operative mortality was 3.4%. Operative mortality of elective cases was 1.6%. The incidences of permanent neurologic deficit, paraparesis, and renal insufficiency were 5.0%, 1.7%, and 7.6%, respectively. Actuarial 4-year survival was 86.5%.
  
  
  CONCLUSIONS
  Total arch replacement with our modified perfusion strategy has demonstrated low operative mortality and morbidity.
authors.affiliation: Department of Cardiovascular Surgery, Sakakibara Heart Institute, Tokyo, Japan.
authors.forename: Shigefumi
authors.initials: S
authors.lastname: Matsuyama
authors.forename: Minoru
authors.initials: M
authors.lastname: Tabata
authors.forename: Tomoki
authors.initials: T
authors.lastname: Shimokawa
authors.forename: Akihito
authors.initials: A
authors.lastname: Matsushita
authors.forename: Toshihiro
authors.initials: T
authors.lastname: Fukui
authors.forename: Shuichiro
authors.initials: S
authors.lastname: Takanashi
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical; D000784:Aortic Dissection / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D001019:Aortic Rupture / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D002315:Cardiopulmonary Bypass; D002560:Cerebrovascular Circulation; D005260:Female; D006324:Heart Arrest, Induced; D017052:Hospital Mortality; D006801:Humans; D007036:Hypothermia, Induced; D007564:Japan; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D020335:Paraparesis / Q000209:etiology; D010477:Perfusion / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D051437:Renal Insufficiency / Q000209:etiology; D013997:Time Factors; D016896:Treatment Outcome