OBJECTIVETo assess the effect of normothermic arch-first technique without extracorporeal circulation in total aortic arch replacement for management of acute Stanford type A dissection.

METHODSThe surgical data were reviewed for 23 patients (age range 32-58 years) with Stanford type A dissection undergoing total aortic arch replacement with the arch-first technique in our department between January, 2006 and November, 2011. During the surgery, a 4-branched prosthetic graft was connected with the inflow tube and femoral artery using the Y-type tube. The 3 aortic branches were disconnected and anastomosed to the respective branches of the graft, with continuous perfusion of the brain by femoral arterial return. After clamping of the ascending aorta, the graft was connected to the remaining arch before the common stem of the graft was anastomosed with the aortic root.

RESULTSThe operations were successfully completed in all the 23 cases with a mean total bypass time of 187∓60 min (117-254 min), mean ascending aorta clamping time of 35∓8 min, and mean nasopharyngeal temperature of 22∓2 celsius;. Death occurred in one case (4.3%) after the operation, and 2 (8.7%) patients experienced temporary neurological dysfunctions. The postoperative consciousness recovery time was 6-8 h in these cases. The shortest postoperative mechanical ventilation time was 18 h, and 11 (48%) patients were weaned from mechanical ventilation within 48 h postoperatively. The ICU stay ranged from 3 to 7 days in these cases.

CONCLUSIONNormothermic arch-first technique without extracorporeal circulation can provide better brain protection and reduced the incidence of postoperative complications by shortening the time of circulation bypass and aortic clamping.