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The Journal of Cardiovascular Surgery 2001 October;42(5):635-7

language: English

Arch-first reconstruction via median sternotomy. Short retrograde cerebral perfusion

Kanda K., Satoh S., Okano T., Shimada Y., Yaku H., Kitamura N.

From the Department of Cardiovascular Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan


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In December 1998, we intro­duced ­arch-­first recon­struc­tion for ­total aor­tic ­arch replace­ment via con­ven­tion­al ­median ster­not­o­my in ­order to short­en the dura­tion of ret­ro­grade cere­bral per­fu­sion (RCP). We ­used a sep­ar­ate ­straight ­graft for an ele­phant ­trunk, ­which ­allowed an ­easy sub­se­quent dis­tal anas­tom­o­sis. The aver­age RCP dura­tion in ­this ­series was 32.1±5.8 min (­mean±SD, ­range, 24-40 min, n=12), ­which was sig­nif­i­cant­ly short­er (p<0.05) ­than ­that of the con­ven­tion­al pro­ce­dure (45.6±12.4 min, ­range, 34-65 min, n=8), in ­which we ­first per­form a dis­tal anas­tom­o­sis. No sig­nif­i­cant dif­fer­enc­es in car­di­o­pul­mo­nary ­bypass ­time (268±81 min vs 258±42 min) nor oper­a­tion ­time (518±213 min vs 517±82 min) ­between the two ­groups ­were ­observed. There was no hos­pi­tal ­death in ­either ­group. One ­patient in the sec­ond ­series (con­ven­tion­al meth­od) suf­fered tem­po­rary neu­ro­log­i­cal dis­tur­bance. For accept­able RCP dura­tion, ­total aor­tic ­arch replace­ment is cur­rent­ly the stan­dard pro­ce­dure in our insti­tu­tion for Stanford A ­type aor­tic dis­sec­tion.

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