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THE JOURNAL OF CARDIOVASCULAR SURGERY
Rivista di Chirurgia Cardiaca, Vascolare e Toracica
Indexed/Abstracted in: BIOSIS Previews, Current Contents/Clinical Medicine, EMBASE, PubMed/MEDLINE, Science Citation Index Expanded (SciSearch), Scopus
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TECHNICAL NOTES CARDIAC SECTION
The Journal of Cardiovascular Surgery 2001 October;42(5):635-7
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
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.