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Arch-First Technique for Aortic Arch Operation Using Branched Graft

Department of Cardiovascular Surgery The Heart Institute of Japan 1 Department of Anesthesiology Tokyo Women’s Medical University Tokyo, Japan
For reprint information contact: Hiroyuki Tsukui, MD Tel: 81 3 3353 8111 Fax: 81 3 3356 0441 email: htsukui{at}jasmine.ocn.ne.jp Department of Cardiovascular Surgery, The Heart Institute of Japan, Tokyo Women’s Medical University, 8-1 Kawada, Shinjuku, Tokyo 162-8666, Japan.

To compare the arch-first technique with conventional aortic arch reconstruction 19 patients were randomly assigned to either procedure. Nine patients underwent the arch-first technique (group A) and 10 underwent the conventional technique (group B). There were no hospital deaths and no significant differences between groups in terms of intraoperative bleeding or the duration of operation cardiopulmonary bypass aortic crossclamping recovery from anesthesia or intensive care. The mean duration of retrograde cerebral perfusion via the superior vena cava was significantly shorter in group A (41.7 ± 10.4 min) than group B (63.9 ± 10 min). Transient neurologic dysfunction was noted in 4 (44%) patients in group A 6 (60%) in group B postoperatively but there was no permanent neurologic dysfunction in either group. The arch-first technique makes it possible to reduce the duration of cerebral ischemia retrograde cerebral perfusion via the superior vena cava reestablish antegrade cerebral perfusion earlier without damaging severely atheromatous arch vessels or conducting retrograde cerebral perfusion via a femoral artery. This technique has the potential to reduce the incidence of neurologic dysfunction.