[Replacement of subtotal aorta in a 2-stage operation; report of a case]

A non-Marfan patient with a chronic type B dissecting aorta suffered acute retrograde dissection during his follow-up period so a subtotal aortic replacement was performed in a scheduled 2-stage operation. During the first operation, this patient underwent replacement of the ascending aorta and aortic arch under continuous retrograde cerebral perfusion (CRCP). In the second operation 3 weeks after the first surgery, replacement of the thoracoabdominal aorta was performed using spinal cord protection under hypothermia. The intercostal arteries were remodeled into a cobra head shape a few pairs at a time. The patient progressed well after the procedures with a mean artery pressure maintained at over 90 mmHg using norepinephrine. We recommended stage surgery, which is safer than current techniques, for entire aortic replacement in centers and hospitals with limited experience of grafting procedure.