Surgical technique:
In the cases of ascending aorta, aortic arch, and aortic root
replacement, the chest was opened via a median sternotomy under general
anesthesia. The bilateral axillary arteries were exposed for arterial
cannulation. Cardiopulmonary bypass (CPB) was established with bilateral
axillary arterial cannulation and bicaval drainage. The patient’s body
temperature was cooled down to 25°C and measured rectally, followed by
implementation of lower body circulatory arrest with moderate
hypothermia. Antegrade selective cerebral perfusion was established by
axillary perfusion with clamped brachiocephalic and left subclavian
arteries and by direct cannulation of the left common carotid artery.
Antegrade cold blood cardioplegia was administered to achieve and
maintain cardiac arrest. Open distal anastomosis was first performed.
The arch vessels were reconstructed individually, and finally, proximal
anastomosis was completed.
In the cases of descending aorta and thoracoabodominal aorta
replacement, the chest was opened via a intercostal space under general
anesthesia.The femoral artery and vein were exposed for cannulation. CPB
was established with the arterial cannulation and right ventricular
drainage via femoral vein. If possible, anastomosis was performed by
aortic clamping with normal temperature. If not possible, the patients’
body temperature was cooled down to 25°C, mesured rectally, followed by
the implementation of lower body circulatory arrest with moderate
hypothermia. Open proximal and distal anastomosis were performed.