%0 Journal Article
%T Selective cerebral perfusion with 4-branch graft total aortic arch replacement: Outcomes in 12 patients
%A Wei-Liang Lai
%A Chiao-Po Hsu
%A Chung-Che Shih
%A Ming-Li Li
%A Ping-chun Li
%J Journal of Cardiothoracic Surgery
%D 2012
%I BioMed Central
%R 10.1186/1749-8090-7-32
%X We retrospectively reviewed the medical records of 12 patients who received TAR, with or without ascending aorta replacement, with a 4-branched graft for Stanford type A dissection (n = 9) or aortic arch aneurysm (n = 3). In all patients surgery was performed with deep hypothermic circulatory arrest (DHCA) with or without retrograde brain perfusion, and selective antegrade brain perfusion (SABP) via the subclavian artery or axillary artery.There were 8 males and 4 females with an average age of 63.14 years. Emergent operations were performed in 9 patients with acute type A aortic dissections. Of all 12 patients, 2 deaths occurred and 1 patient experienced lower extremity paraplegia resulting in an in-hospital mortality rate of 16.6% and a permanent neurological deficit rate of 8.3%.The use of a 4-branched graft, hypothermic circulatory arrest, and SABP is a useful operative method for aortic arch replacement with acceptable morbidity and mortality.Aortic arch surgery is associated with significant morbidity and mortality, and neurologic dysfunction remains a major complication of operations that involve total aortic arch replacement (TAR). There are 2 general methods of protecting the brain during extensive surgical procedures, deep hypothermic circulatory arrest (DHCA) with or without retrograde brain perfusion, and selective antegrade brain perfusion (SABP) via the subclavian artery or axillary artery [1,2]. DHCA should not exceed 45 to 50 min, but provides a dry operation field. SABP introduces the risk of embolization of atheromatous debris or air, but provides oxygenated blood to the brain and reduces pump time and the risk of hypothermia-related complications such as pulmonary insufficiency and coagulopathy [3-5]. Therefore, SABP is currently considered to be the most reliable method of preventing brain ischemia [6].Many techniques have been developed for replacement of the aortic arch, and the choice often relies on the unique clinical situation of a patient
%K Aortic arch aneurysm
%K Type A aortic dissection
%K Branched aortic graft
%U http://www.cardiothoracicsurgery.org/content/7/1/32