[Redo arch replacement after ascending aortic surgery]

Redo aortic arch replacement is mainly performed in the patients who underwent the ascending aortic surgery for the acute type A aortic dissection previously, and still carries relatively high mortality up to 13.8% according to the 2010 annual report by The Japanese Association for Thoracic Surgery. It has been reported that the incidence of late reoperations after the initial proximal aortic surgery for aortic dissection is between 4 and 28%, and preoperative renal failure and impaired cardiac function are the predictors of increased in-hospital mortality after redo aortic surgery. As preoperative examinations,the electrocardiogram (ECG)-gated computed tomography is useful for precise assessment of proximal aorta and coronary arteries. In the case with retrosternal pseudoaneurysm of proximal aorta, the cerebral perfusion establishment via selective direct cannulation into common carotid arteries prior to performing a sternotomy is one of the strategies to prevent neurological complications. For the distal anastomosis during a redo arch replacement, it is also important to consider the potential staged operations to the residual lesions of the descending thoracic aorta, i.e., insertion of an elephant trunk. Based on the well considered surgical plan, redo aortic arch surgery could be safely performed with acceptable morbidity and mortality.