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Eur J Cardiothorac Surg 2006;29:255-257
© 2006 Elsevier Science NL

How-to-do-it

Total arch replacement using a stepwise distal anastomosis for arch aneurysms with distal extension

^a Department of Cardiovascular Surgery, National Cardiovascular Center, 5-7-1 Fujishirodai, Suita, Osaka 565-8565, Japan
^b Department of Thoracic Surgery, Fujita Health University, Mizukake-cho, Toyoake, Aichi 470-1192, Japan

Received 2 August 2005; received in revised form 17 October 2005; accepted 19 October 2005.

^_* Corresponding author. Tel. +81 6 6833 5012; fax: +81 6 6872 7486. (Email: hogino{at}hsp.ncvc.go.jp).

A total of 120 patients having arch to distal arch aneurysm with downstream extension underwent total arch replacement, with individual arch-vessel reconstruction through median sternotomy using a novel ‘stepwise’ distal aortic anastomosis. Cardiopulmonary bypass was established by cannulating the right axillary artery and the ascending aorta or femoral artery. Hypothermia was at 22–28 °C. Through the aneurysm, the descending aorta was divided. Distal anastomosis using the stepwise technique was performed; a tube graft of length 7–12 cm was inserted into the descending aorta and anastomosed by running suture. The distal end of the inserted graft was extracted, and a further four-branched arch graft was joined to it. Selective cerebral perfusion was used for cerebral safety during arch repair. There were three hospital deaths (2.5%). Two patients (1.7%) developed permanent neurological dysfunction and three patients (2.5%) suffered transient cerebral deficits. Three patients (2.5%) required reentry for postoperative bleeding although in none of them bleeding was from the distal anastomosis site with the stepwise technique. Stepwise anastomosis is a useful and secure alternative for distal anastomosis in total arch replacement for arch to distal arch aneurysms with distal extension.

Key Words: Aortic arch • Aneurysm • Aortic dissection • Aortic surgery

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				H. Sasaki, H. Ogino, H. Matsuda, K. Minatoya, M. Ando, and S. Kitamura Integrated Total Arch Replacement Using Selective Cerebral Perfusion: A 6-Year Experience Ann. Thorac. Surg., February 1, 2007; 83(2): S805 - S810. [Abstract] [Full Text] [PDF]