Operative techniques
Our basic surgical strategies of central repair operations for ATAAD are
as follows. As arterial infusion lines
for cardiopulmonary
bypass, both the axillary
and femoral
arteries were regularly used. The absence of true-lumen collapse was
always confirmed on transesophageal or epi-aortic echography at the
start
of extracorporeal
circulation. In some patients, ascending aorta was clamped and proximal
procedure was started during systemic cooling. For brain protection,
antegrade
selective cerebral
perfusion was performed. Under hypothermic circulatory arrest with
rectal temperature 25℃, balloon-tipped cannulas with pressure monitor
lines were inserted individually to a brachiocephalic artery (BCA), left
common carotid artery (LCCA), and left subclavian artery (LSCA) from the
true lumen of the aortic arch. Cerebral perfusion was conducted by three
separate small roller pumps. Start-up perfusion flow rate was 5ml/kg for
BCA, 3.3ml/kg for LCCA, and 1.7ml/kg for LSCA, and was regulated to keep
adequate perfusion pressure and regional oxygen saturation of frontal
lobe. The extent
of aortic
replacement was determined on the basis of the entry site.