Conventional aortic arch replacement

Aortic arch surgery has long been associated with a high morbidity (transient 6-38% and permanent 2-16% neurological dysfunction) and high mortality (10-44%). The optimization of surgical and peri-operative management and the implementation of new surgical strategies have led to significantly better outcomes. Nowadays open surgical interventions of the aortic arch should be performed with antegrade selective cerebral perfusion via the subclavian or carotid artery during hypothermic circulatory arrest at a temperature of 18-20A degrees C. As a result the mortality rates (9-10%) and stroke (1-5%) have been considerably reduced. In terms of neurological outcomes of these patients, bilateral cerebral perfusion has proved to be superior to unilateral cerebral perfusion. Our investigations have demonstrated that the"direct true lumen cannulation" technique provides good results in high-risk patients undergoing surgery for type-A aortic dissection.