[Aortic arch aneurysm: new modification of aortic arch reconstruction and selective cerebral perfusion]

Selective cerebral perfusion (SCP) has been widely used as the method for cerebral protection during aortic arch repair in the treatment of aortic arch aneurysms in our institution. Recently, we modified our technique of aortic arch reconstruction and SCP in order to reduce the neurological complication. Following institution of SCP into both innominate and left common carotid arteries at 22 degrees C, the distal graft anastomosis and left subclavian reconstruction were performed while the descending aorta was left opened. Then the antegrade perfusion with rewarming was started via the fourth limbs attached to the main graft instead of the femoral artery. The aortic arch was completely replaced with the graft with three limbs for arch vessels. During one-year period from December 1993 to November 1994, 30 patients were operated on for aortic arch aneurysms using this technique. The etiology of aneurysms was true aneurysms in 16 patients, and aortic dissection in 14 including 8 cases of acute dissection. The concomitant procedures included descending graft replacement in 11 patients, composite graft replacement in 5, CABG in 3, and AVR in 1. The hospital mortality was 3.3% (1 of the 30 patients). There was no neurological complication. We conclude that the present techniques are useful methods for preventing the neurological complication in the treatment of aortic arch aneurysms.