[A case of extended surgery in acute aortic dissection by perfusion into extra anatomic bypass]

Total aortic arch replacement creates various problems involving surgical techniques, myocardial protection and perfusion methods. The most important problem during this procedure is cerebral ischemia. We developed a technique to prevent this problem by bypass grafting through the right axillo-left external carotid-left axillary artery and perfusing the brain continuously through the side branch attached to this bypass graft. A 62-year-old man with acute aortic dissection underwent ascending aorta and total aortic arch replacement using this alterative perfusion method. No cerebral dysfunction was seen in this case. The advantages of this method are as follows: there is no time limit required even for total aortic arch replacement; adequate and reliable anastomosis is possible; the dissecting aortic branches are not touched directly; it is possible to prevent cerebral infarction caused by mural thrombus and pieces of atherosclerotic plaque by clamping the aorta and aortic arch branches; and it is possible to prevent air embolism.