Modified trifurcated graft in acute type A aortic dissection with the least brain ischemic time

Cerebral ischemia, bleeding, and inadequate myocardial protection are the major concerns in doing aortic arch operation. The trifurcated graft technique as described by Spielvogel and associates was a useful technique in reducing the risk of postoperative neurologic complications. However, the cerebral ischemic time may be still too long in inexperienced hands. We recently encountered 3 patients of acute type A aortic dissection who needed aortic arch replacement. By modifying the procedure of the trifurcated graft technique and using a reversed sleeve graft technique, we greatly reduced the duration of cerebral and myocardial ischemia and made bleeding a minor problem.