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 a
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 B |
Fig. 1 a: Proximal first technique for total aortic arch
replacement (1) Proximal anastomosis under cross-clamping of the ascending aorta
followed by an immediate coronary reperfusion is the first procedure. Arch vessel
reconstruction under deep hypothermia, lower than 20ÍC at the rectal temperature
and retrograde cerebral perfusion is followed.
b: Proximal first technique for total aortic arch replacement (2)
The cerebral circulation is restored after arch vessel reconstruction and open
distal anastomosis with a modified elephant trunk technique under lower body circulatory
arrest is performed. Graft to graft anastomosis is the last procedure. |
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| Fig. 2 A newly developed sealed branched graft is shown.
The first branch for arterial perfusion is attached more proximal than a usual
one. |
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| Table 2 Operative results |
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| Fig. 3 Relationship between the interval, from the end
of anesthesia to the time the patients wake up, and SCP or RCP duration. There
was no significant correlation between two parameters. SCP: selective cerebral
perfusion, RCP:retrograde cerebral perfusion |
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