Arch first technique under deep hypothermic circulatory arrest with retrograde cerebral perfusion

We have adopted the arch first technique with four-branched graft for total arch replacement since 1998 to reduce the period of deep hypothermic circulatory arrest and the retrograde cerebral perfusion time. This procedure was performed in 85 cases (58 males and 27 females), with an average age of 68 years. There were 61 true aneurysms, 21 aortic dissections and 3 others. Stroke was a complication in 6 cases (7%). Other morbidities were re-exploration for bleeding in 9, low output syndrome in 2, and renal dysfunction in 3. There were 3 hospital deaths (3.5%), 4 late deaths. The five-year survival rate was 89.1%. The arch first technique results in low surgical mortality and morbidity and provides a higher survival rate. The arch first technique is an excellent method for total arch replacement.