• Atsushi Omura, Kenji Okada, Hiroya Kano, Toshihito Sakamoto, Takeshi Inoue, Masamichi Matsumori, and Yutaka Okita.
• Department of Cardiovascular Surgery, Kobe University School of Medicine, Kobe, Japan.
• Kyobu Geka. 2013 Oct 1;66(11):969-75.

ObjectiveWe report our current surgical management and early and late outcomes of total arch replacement.MethodFrom October 1999 to December 2012, 372 consecutive patients (mean age 71.8±12.0) underwent total arch replacement through a median sternotomy at our institute. Mean Japan score (predicted 30 day mortality) was 8.0±9.2( median 4.4). Our current surgical approach included the following:(1) meticulous selection of arterial cannulation site and type of arterial cannula;(2) circulatory arrest at tympanic temperature (below 23 °C) and rectal temperature (below 30 °C);(3) antegrade selective cerebral perfusion and cerebral monitoring of regional cerebral saturation;(4) early rewarming just after distal anastomosis;(5)maintaining fluid balance below 1,000 ml during cardiopulmonary bypass.ResultsOverall 30 day and in-hospital mortality was 1.6%( 6/372) and 3.8%( 14/372), and was 1.0%(3/308)and 2.6% (8/308) in elective cases. Permanent neurologic deficit occurred in 2.2%(8/372) of patients. The mean follow up period were46±39months(range2~165 months). Survival at 5 and 10 years after surgery was 75.8±2.8% and 66.0±3.8%, respectively. During follow up period, there was only one total arch replacement related problem (proximal anastomosis aneurysm). Freedom from additional aortic surgery and aortic related event at 5 and 10 years was 90.8 ±2.2% and 86.1±3.4%,respectively.ConclusionOur current approach for total aortic arch replacement was associated with low hospital mortality and morbidities and with favorable long-term outcome.

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