Less invasive quick replacement of the proximal arch with aggressive rapid rewarming for type A acute aortic dissection

We describe a newly modified technique, which we term “less invasive quick replacement” (LIQR) for type A acute aortic dissection (AAD). After cooling to a rectal temperature of 28°C without any cerebral perfusion, circulating blood in the cardiopulmonary bypass (CPB) circuit was warmed up to 40°C during open distal anastomosis. As soon as the distal anastomosis was completed, rapid rewarming was initiated by perfusing blood at 40°C. The average CPB and total operative times were 71.8 ± 9.6 and 130.6 ± 7.7 min, respectively. The shortest operative time was 101 min from skin incision to skin closure. All patients were weaned off the ventilator within 12 h of surgery. The postoperative hospital stay was 9.3 ± 1.2 days. There was no incidence of cerebral damage or hospital mortality. Our initial results showed LIQR to be safe and effective.