Aortic arch replacement without circulatory arrest or deep hypothermia: The "branch-first" technique

Abstract

Objective Although current developments in aortic arch replacement have demonstrated progressively improving mortality, cerebral morbidity remains significant. We describe a "branch-first" technique that avoids circulatory arrest and profound hypothermia, yielding excellent survival and low cerebral morbidity. Methods From September 2005 to February 2014, 64 patients underwent the "branch-first" technique for aortic arch replacement. Each arch branch is individually isolated for a brief period while it is anastomosed to a perfused trifurcation graft. The disconnection-reconnection sequence proceeds from the innominate artery to the left subclavian artery, with uninterrupted perfusion of the ..