Use of the retrograde "pull-through" technique

A 50-year-old man, who 9 months earlier had undergone emergency operation for acute type I aortic dissection, was readmitted to our hospital with the diagnosis of an enlarging aneurysm of the false lumen involving the transverse arch and the proximal third of the descending thoracic aorta, due principally to redissection at the distal suture line of the ascending aortic graft. Replacement of the aortic arch and proximal descending thoracic aorta was performed by using the retrograde "pull-through" technique with hypothermic circulatory arrest and retrograde cerebral perfusion. Although circulatory arrest lasted 110 minutes, the patient was extubated on the 2nd postoperative day and had no central or peripheral neurologic damage. Mild, transitory renal dysfunction was observed in the 1st postoperative week, and the patient was discharged on the 18th postoperative day. He is asymtomatic at 15 postoperative months. Deep hypothermia and retrograde cerebral perfusion proved effective despite prolonged circulatory arrest. The retrograde "pull-through" technique is an effective method of replacing the entire thoracic aorta and should probably be considered for single-stage repair of acute type I aortic dissection with multiple intimal tears.