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Eur J Cardiothorac Surg 2001;19:25-29
© 2001 Elsevier Science NL

Aortic arch repairs through three different approaches

^a Department of Cardiovascular Surgery, National Cardiovascular Center, 5-7-1 Fujishirodai, Suita, Osaka 565-8565, Japan
^b Department of Thoracic Surgery, Nagoya University, School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi 466-8550, Japan
^c Department of Cardiovascular Surgery, Tenri Hospital, 200 Mishima-cho, Tenri, Nara 632-8552, Japan

Received 22 May 2000; received in revised form 18 September 2000; accepted 19 October 2000.

Corresponding author. Tel.: +81-6-6833-5012; fax: +81-6-6872-7486
e-mail: hogino{at}hsp.ncvc.go.jp

Objectives: The outcome of aortic arch repairs by means of three different approaches between 1990 and January 2000 was reviewed. Methods: In total 39 patients aged 71.5±6.2 years were operated on. The three different surgical approaches depended on the anatomical positions of the aneurysms and on their proximal or distal extension; a median approach was employed in 23 patients, whereas a left postero-lateral approach was used in eight patients. More recently, in eight cases a left antero-lateral approach was applied. All patients underwent open aortic anastomosis without any clamp on or around the aortic arch. During the procedure, the brain was protected by a combination of profound hypothermic circulatory arrest and several techniques of retrograde cerebral perfusion. Results: Permanent cerebral dysfunction occurred in four patients: two in the median approach and two in the left postero-lateral approach. There were two hospital deaths (5.3%) and six late deaths, all of which belonged either to the median group or to the postero-lateral group. The antero-lateral approach did not produce any cerebral dysfunction, early death, or late death. Conclusions: The outcome of aortic arch repairs using profound hypothermic circulatory arrest and variable techniques of retrograde cerebral perfusion, by means of three different approaches, was satisfactory. Of the three approaches, the antero-lateral approach can be employed easily, whether aneurysms extend proximally or distally.

Key Words: Aortic arch repair • Surgical approach • Hypothermic circulatory arrest • Retrograde cerebral perfusion • Open aortic anastomosis

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