[Staged operation for aneurysm of the entire aorta: report of four cases]

Between September 1989 and May 1994, 3 patients with aortic dissection and one with atherosclerotic total aortic aneurysm associated with annuloaortic ectasia underwent successful staged operation for aneurysm of the entire aorta and aortic regurgitation. A composite graft was used for total aortic root replacement. Carbrol and Piehler techniques, Carrel patch and saphenous vein grafting were employed for coronary artery reconstruction. En bloc arch reconstruction was performed in one patient and three vessels graft replacement in 3 patients under hypothermic separate cerebral perfusion. Combined antegrade with retrograde oxygenated crystalloid cardioplegia and terminal warm blood cardioplegia were used for myocardial protection during prolonged aortic cross clamping in a simultaneous total aortic root and arch replacement. Elephant trunk was used at the distal arch anastomosis in 3 patients and useful for following thoracoabdominal surgery. In 3 patients, separate perfusion of upper and lower body technique with moderate hypothermia was employed and seemed to be useful in the patients who require extensive thoracoabdominal replacement to prevent spinal cord injury. All patients had no major complications and have been well.