[Treatment of aneurysms of the aortic arch]

Graft replacement therapy was employed in the treatment of 28 patients with aneurysms involving the aortic arch. Of the 28 patients, 14 had true aneurysms, 13 dissecting aneurysms, and 1 pseudoaneurysm. The operative mortality was 75% (6 of 8 patients) between 1979 and 1986, whereas it was 10% (2 of 20 patients) between 1987 and 1989. Temporary or permanent bypass with vascular graft or heparin coated tube were used in 10 patients (7 patients in the early period, 3 patients in the later period). In this group, 50% hospital mortality occurred. Cardiopulmonary bypass and separate cerebral circulation were used in 16 patients (1 case in the early period, 15 patients in the later period). Thirteen of 16 patients survived this technique. In 2 patients, both in later period, profound hypothermia and circulatory arrest were used. Two patients survived without neurological deficit. Operative mortality decreased since 1987 by the change of bypass technique and operative procedures.