[Total aortic arch graft replacement: strategy for shortening the duration of cardiac ischemic arrest]

Between August 1991 and November 1993, five patients underwent total aortic arch graft replacement in a manner which placed emphasis on myocardial protection. All operations were performed with the use of extracorporeal circulation and selective cerebral perfusion. Oxygenated warm blood was infused at a flow rate of 300 ml/min. via a catheter inserted proximal to the site of occlusion of the ascending aorta or replaced graft of the ascending aorta. After the beating of the heart was resumed under left venting, aortic arch was replaced using a prosthetic graft with three branches. Concomitant operations were reconstructions of the aortic root with composite graft (Bentall's technique) in two patients of Marfan's syndrome and type A aortic dissection. All patients were easily taken off cardiopulmonary bypass and postoperative course was uneventful. We believe that shortening of the duration of ischemic cardiac arrest is important if surgical results of total aortic arch replacement are to be further improved, above all in patients at high risk for surgery, such as elderly subjects whose organ function is often compromised.