Related Experiment Video
Updated: May 15, 2026
Comprehensive Endovascular and Open Surgical Management of Cerebral Arteriovenous Malformations
Published on: October 20, 2017
Total arch replacement using antegrade cerebral perfusion
Yutaka Okita1, Kenji Okada, Atsushi Omura
1Division of Cardiovascular Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan. yokita@med.kobe-u.ac.jp
Insights
Total aortic arch replacement using antegrade cerebral perfusion demonstrates low hospital mortality and morbidity. This surgical technique offers favorable long-term survival rates for patients with complex aortic conditions.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Vascular Surgery
Background:
- Aortic arch replacement is a complex procedure with significant risks.
- Antegrade cerebral perfusion (ACP) is a technique used to protect the brain during aortic arch surgery.
- Optimizing surgical techniques is crucial for improving patient outcomes.
Purpose of the Study:
- To present the technical details of total aortic arch replacement using antegrade cerebral perfusion.
- To evaluate the safety and efficacy of this approach in a large patient cohort.
- To identify risk factors for hospital mortality and assess long-term outcomes.
Main Methods:
- A retrospective review of 423 consecutive patients undergoing total aortic arch replacement with ACP from 2002 to 2012.
- Detailed description of surgical technique including cannulation, ACP management, temperature control, and graft selection.
- Analysis of perioperative outcomes, hospital mortality, permanent neurologic deficits, and long-term survival.
Main Results:
- Overall hospital mortality was 4.5%, with lower rates in elective cases (2.1%) compared to urgent/emergency cases (9.6%).
- Permanent neurologic deficits occurred in 3.3% of patients.
- Five- and 10-year survival rates were 79.6% and 71.2%, respectively, with excellent outcomes in acute aortic dissection patients.
Conclusions:
- The presented approach for total aortic arch replacement with antegrade cerebral perfusion is associated with low hospital mortality and morbidity.
- This technique leads to favorable long-term outcomes and survival.
- Meticulous surgical technique and patient selection are key to successful aortic arch repair.
Objective:
The technical details of total arch replacement using antegrade cerebral perfusion are presented.
Methods:
From January 2002 to May 2012, 423 consecutive patients (mean age, 69.2 ± 13.1 years) underwent total arch replacement using antegrade selective cerebral perfusion through a median sternotomy. Acute aortic dissection was present in 81 patients (19.1%; 75 type A, 6 type B), and a shaggy aorta was present in 37 patients (8.7%). Emergency/urgent surgery was required in 135 patients (31.9%). Our current approach included meticulous selection of the arterial cannulation site and type of arterial cannula, antegrade selective cerebral perfusion, maintenance of the minimal tympanic temperature between 20 °C and 23 °C, early rewarming immediately after distal anastomosis, and maintenance of the fluid balance at less than 1000 mL during cardiopulmonary bypass. A woven Dacron 4-branch graft was used in all patients.
Results:
The overall hospital mortality was 4.5% (19/423): 9.6% (13/135) in urgent/emergency surgery cases and 2.1% (6/288) in elective cases. Permanent neurologic deficits occurred in 3.3% patients (14/423). Prolonged ventilation was necessary in 57 patients (13.4%). A multivariate analysis demonstrated the risk factors for hospital mortality to be age (octogenarian; odds ratio, 4.45; P = .02), brain malperfusion (odds ratio, 22.5; P = .002), and cardiopulmonary bypass time (odds ratio, 1.06; P = .04). The follow-up was completed in 97.2% of patients (mean, 29 ± 27; 1-126) and included 2.3 patients per year. Survival at 5 and 10 years after surgery was 79.6% ± 3.3% and 71.2% ± 5.0%, respectively. In the acute A dissection group, the 10-year survival was 96.6% ± 2.4%. In the elective nondissection group, the 5- and 10-year survivals were 80.3% ± 4.2% and 76.1% ± 5.7%, respectively.
Conclusions:
Our current approach for total aortic arch replacement is associated with low hospital mortality and morbidity, thus leading to a favorable long-term outcome.
