title: Total arch replacement with separated graft technique and selective antegrade cerebral perfusion.
abstract: It is essential to select the optimum method of cerebral protection and operative technique for arch repair to improve the surgical outcome of arch aneurysm or dissection. Selective antegrade cerebral perfusion (SACP) is our current method of choice if required cerebral protection time exceeds 30 minutes. Moderate hypothermic two-arch vessel perfusion (innominate artery or right axillary artery and left common carotid artery) is safe and effective for brain protection in a majority of patients. The separated graft technique using 4-branched graft is now our preferred surgical procedure used for arch aneurysm or dissection because this technique presents several advantages over the en-bloc or island technique. SACP allows us to perform meticulous arch repair and facilitates the time-consuming total arch replacement for complex aortic arch pathology and results in an acceptable mortality (less than 4%) and morbidity (stroke 3%).
authors: Hamamatsu University School of Medicine, Hamamatsu, Japan; ; Cardio-Vascular Center Hokkaido Ohno Hospital, Sapporo, Japan.
authors: Teruhisa
authors: T
authors: Kazui
keywords: Open aortic arch repair; antegrade selective cerebral perfusion; moderately hypothermic two-arch vessel perfusion; separated graft technique brain protection; total arch replacement
references: Ann Thorac Surg. 1996 May;61(5):1348-54
references: 8633939
references: J Thorac Cardiovasc Surg. 2000 Mar;119(3):558-65
references: 10694617
references: J Cardiovasc Surg (Torino). 1990 Sep-Oct;31(5):553-8
references: 2229147
references: Ann Thorac Surg. 1994 Nov;58(5):1462-8
references: 7979676
references: Ann Thorac Surg. 2004 Jun;77(6):2021-8
references: 15172258
references: Ann Thorac Surg. 1999 Jun;67(6):1874-8; discussion 1891-4
references: 10391330
references: J Thorac Cardiovasc Surg. 2001 Mar;121(3):491-9
references: 11241084
references: J Thorac Cardiovasc Surg. 1994 Mar;107(3):788-97; discussion 797-9
references: 8127108
references: Ann Thorac Surg. 2000 Jul;70(1):3-8; discussion 8-9
references: 10921673