Total arch replacement using a 4-branched graft with antegrade cerebral perfusion

Objective: Total arch replacement (TAR) is an established standard surgical procedure. We report > 1000 cases of TAR using a 4-branched graft with antegrade cerebral perfusion (ACP) during a 15-year period. Methods: Since May 2001, 1005 patients who underwent total aortic replacement (mean age 69.8 +/- 11.2 years; range, 9-92 years; 744 male) underwent TAR with a 4-branched graft. All surgeries were performed under hypothermia with ACP. There were 252 emergent operations for acute aortic dissection or aneurysm rupture. Concomitant operations included coronary arterial bypass grafting in 196 patients, aortic valve repair or replacement in 64, and aortic root replacements in 38. Results: The operation time was 482 +/- 171 minutes, cardiopulmonary time was 254 +/- 94 minutes, cardiac ischemia time was 145 +/- 51 minutes, ACP time was 160 +/- 47 minutes, and lower body circulatory arrest time was 62 +/- 16 minutes. The hospital mortality rate was 5.2%. The permanent neurological dysfunction rate was 3.6% and temporary neurological dysfunction rate was 6.4%. There were no spinal cord complications. The 5-year survival rate was 80.7% and 10-year survival rate was 63.1%. Fifteen patients (1.5%) underwent reoperation for the arch grafts because of a pseudoaneurysm (11 patients), hemolysis (3 patients), and infection (1 patient). Conclusions: TAR using a 4-branched graft with ACP could be accomplished with acceptable short- and long-term results.