title: Recent advancements of total aortic arch replacement.
abstract: OBJECTIVE
  Recent advancements in total aortic arch replacement achieved by our approach were presented.
  
  
  METHODS
  From January 2002 to December 2010, 321 consecutive patients (mean age 69.8 ± 13.3 years) underwent total arch replacement through a median sternotomy at our institute. Aortic dissection was present in 94 (28.3%) patients and shaggy aorta in 36 (11.2%), with emergency/urgent surgery required in 106 (33.0%). Our current approach included the following: (1) meticulous selection of arterial cannulation site and type of arterial cannula; (2) antegrade selective cerebral perfusion; (3) maintenance of minimal tympanic temperature between 20 °C and 23 °C; (4) early rewarming just after distal anastomosis; (5) after 2004, bolus injection of 100 mg of sivelestat sodium hydrate into the pump circuit at the initiation of cardiopulmonary bypass; (6) after 2006, maintaining fluid balance below 1000 mL during cardiopulmonary bypass.
  
  
  RESULTS
  Overall hospital mortality was 4.4% (14/321) and was 1.9% (4/215) in elective cases. Permanent neurologic deficit occurred in 4.4% (14/321) of patients and in 2.8% (6/215) of elective cases. Prolonged ventilation was necessary in 53 (16.5%), with a significant reduction after 2006 (22.8% vs 12.6%; P = .02). Multivariate analysis demonstrated that risk factors for hospital mortality were octogenarian (odds ratio, 4.32; P = .03), brain malperfusion (odds ratio, 21.2; P = .001) and cardiopulmonary bypass time (odds ratio, 1.01; P = .04). Survival at 3 and 5 years after surgery was 82.4% ± 2.5% and 78.5% ± 3.1%, respectively.
  
  
  CONCLUSIONS
  Our current approach for total aortic arch replacement was associated with low hospital mortality and morbidities and with favorable long-term outcome.
authors.affiliation: Division of Cardiovascular Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan.
authors.forename: Kenji
authors.initials: K
authors.lastname: Okada
authors.forename: Atsushi
authors.initials: A
authors.lastname: Omura
authors.forename: Hiroya
authors.initials: H
authors.lastname: Kano
authors.forename: Toshihito
authors.initials: T
authors.lastname: Sakamoto
authors.forename: Akiko
authors.initials: A
authors.lastname: Tanaka
authors.forename: Takeshi
authors.initials: T
authors.lastname: Inoue
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Okita
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical; D000784:Aortic Dissection / Q000401:mortality / Q000601:surgery*; D001013:Aorta, Thoracic / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000401:mortality / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods*; D001833:Body Temperature Regulation; D002315:Cardiopulmonary Bypass; D016009:Chi-Square Distribution; D004638:Emergency Treatment; D005260:Female; D005998:Glycine / Q000008:administration & dosage / Q000031:analogs & derivatives; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D015842:Serine Proteinase Inhibitors / Q000008:administration & dosage; D056346:Sternotomy; D013449:Sulfonamides / Q000008:administration & dosage; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D015842:Serine Proteinase Inhibitors; D013449:Sulfonamides; C069195:sivelestat; D005998:Glycine