• Maral Ouzounian, Scott A LeMaire, and Joseph S Coselli.
• Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas; Cardiovascular Surgery Service, The Texas Heart Institute, St. Luke's Health System, Houston, Texas.
• Semin. Thorac. Cardiovasc. Surg. 2013 Jan 1;25(2):107-15.

AbstractSurgical procedures for the treatment of complex aortic arch pathology remain among the most challenging cardiovascular operations, incurring considerable risk for death and stroke. The purpose of this article is to describe the evolution of our approach to open repair of the aortic arch. Our arterial cannulation strategy has shifted from femoral and direct aortic to right axillary and more recently innominate artery cannulation. This transition has facilitated the administration of continuous antegrade cerebral perfusion and more moderate levels of hypothermia during complex repairs. Modifications in surgical technique, including arch reconstruction with the trifurcated graft, and the classical and frozen elephant trunk techniques have simplified the conduct of the operation. Experimental and clinical research supporting the evolution of our approach is discussed in this paper.Copyright © 2013 Elsevier Inc. All rights reserved.

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