Aortic arch repairs through three different approaches

Objectives: The outcome of aortic arch repairs by means of three different approaches between 1990 and January 2000 was reviewed. Methods: In total 39 patients aged 71.5 +/- 6.2 years were operated on. The three different sur gical approaches depended on the anatomical positions of the aneurysms and on their proximal or distal extension; a median approach was employed in 23 patients, whereas a left posterolateral approach was used in eight patient s. Mon recently, in eight cases a left antero-lateral approach was applied. All patients underwent open aortic anastomosis without any clamp on or aro und the aortic arch. During the procedure, the brain was protected by a com bination of profound hypothermic circulatory arrest and several techniques of retrograde cerebral perfusion. Results: Permanent cerebral dysfunction o ccurred in four patients: two in the median approach and two in the left po stero-lateral approach. There were two hospital deaths (5.3%) and six late deaths, all of which belonged either to the median group or to the postero- lateral group. The antero-lateral approach did not produce any cerebral dys function, early death, or late death. Conclusions: The outcome of aortic ar ch repairs using profound hypothermic circulatory arrest and variable techn iques of retrograde cerebral perfusion, by means of three different approac hes, was satisfactory. Of the three approaches, the antero-lateral approach can be employed easily, whether aneurysms extend proximally or distally. ( C) 2001 Elsevier Science B.V. All rights reserved.