• Yutaka Okita, Kenji Okada, Atsushi Omura, Hiroya Kano, Hitoshi Minami, Takeshi Inoue, and Shunsuke Miyahara.
• Division of Cardiovascular Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan. yokita@med.kobe-u.ac.jp
• J. Thorac. Cardiovasc. Surg.. 2013 Mar 1;145(3 Suppl):S63-71.

ObjectiveThe technical details of total arch replacement using antegrade cerebral perfusion are presented.MethodsFrom January 2002 to May 2012, 423 consecutive patients (mean age, 69.2 ± 13.1 years) underwent total arch replacement using antegrade selective cerebral perfusion through a median sternotomy. Acute aortic dissection was present in 81 patients (19.1%; 75 type A, 6 type B), and a shaggy aorta was present in 37 patients (8.7%). Emergency/urgent surgery was required in 135 patients (31.9%). Our current approach included meticulous selection of the arterial cannulation site and type of arterial cannula, antegrade selective cerebral perfusion, maintenance of the minimal tympanic temperature between 20 °C and 23 °C, early rewarming immediately after distal anastomosis, and maintenance of the fluid balance at less than 1000 mL during cardiopulmonary bypass. A woven Dacron 4-branch graft was used in all patients.ResultsThe overall hospital mortality was 4.5% (19/423): 9.6% (13/135) in urgent/emergency surgery cases and 2.1% (6/288) in elective cases. Permanent neurologic deficits occurred in 3.3% patients (14/423). Prolonged ventilation was necessary in 57 patients (13.4%). A multivariate analysis demonstrated the risk factors for hospital mortality to be age (octogenarian; odds ratio, 4.45; P = .02), brain malperfusion (odds ratio, 22.5; P = .002), and cardiopulmonary bypass time (odds ratio, 1.06; P = .04). The follow-up was completed in 97.2% of patients (mean, 29 ± 27; 1-126) and included 2.3 patients per year. Survival at 5 and 10 years after surgery was 79.6% ± 3.3% and 71.2% ± 5.0%, respectively. In the acute A dissection group, the 10-year survival was 96.6% ± 2.4%. In the elective nondissection group, the 5- and 10-year survivals were 80.3% ± 4.2% and 76.1% ± 5.7%, respectively.ConclusionsOur current approach for total aortic arch replacement is associated with low hospital mortality and morbidity, thus leading to a favorable long-term outcome.Copyright © 2013 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.

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