Korean J Thorac Cardiovasc Surg.  2000 Aug;33(8):676-680.

Arch-First Technique in Aortic Arch Aneurysm

• Park KH
• Choi SC
• Choi KJ
• Lee YH
• Hwang YH
• Cho KH

Abstract

To minimize the period of brain ischemia and the potential for neurologic damage during aortic arch replacement, we used the arch-first technique. First case was a 28-year-old female with extensive aneurysm involving ascending, arch and descending thoracic aorta. Exposure was obtained via a bilateral via a bilateral thoracotomy (clamshell incision) in the anterior 4th right and 3rd left intercostal space with oblique sternotomy. To prepare for arch perfusion, the side-arm graft(10mm) was anastomosed to the aortic graft, opposite the site of the planned anastomosis to the arch vessels. After completing the arch anastomosis under total circulatory arrest(37min) and retrograde cerebral perfusion(12min), aortic graft was clamped on either side and the arch was perfused via side-arm graft for 36min. When distal aortic anastomosis was finished, distal clamp of aortic graft was released and arch vessels were perfused via common femoral artery, and the proximal aortic anastomosis was accomplished. The patient was discharged with no event. Second case was a 48-year-old male with extensive aneurysm involving ascending, arch, and aortic regurgitaiton(grade III/IV). This case was also done using the clamshell incision. Aortic valve replacement was done by valved-conduit(Vascutek 30mm), both coronary artery anastomosis using Cabrol's procedure. Last operation procedure was the same as the 1st case.

MeSH Terms

Adult
Aneurysm*
Aorta, Thoracic*
Aortic Valve
Brain Ischemia
Coronary Vessels
Female
Femoral Artery
Humans
Male
Middle Aged
Perfusion
Sternotomy
Thoracotomy
Transplants