[Two cases of total arch replacement after coronary artery bypass surgery with internal mammary artery graft]

We report two successful cases of total arch replacement after coronary artery bypass surgery (CABG) using internal mammary artery graft (ITA). Case 1 had a true aneurysm of the distal aortic arch occurring 7 years after CABG using left ITA, and case 2 had a dissecting aneurysm of DeBakey II occurring 10 months after CABG using right ITA. This patient was also complicated by a preexisting true aneurysm of the proximal descending aorta. Both cases were managed by repeat midsternal incision, selective cerebral perfusion (SCP) and retrograde cardioplegia. In both cases, functioning ITAs were dissected out easily without injury, and an operative filed for total arch replacement was well obtained under the cardioplegia and brain protection mentioned above.