Integrated Total Arch Replacement Using Selective Cerebral Perfusion: A 6-Year Experience Hiroaki Sasaki, MD, Hitoshi Ogino, MD, Hitoshi Matsuda, MD,

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Integrated Total Arch Replacement Using Selective Cerebral Perfusion: A 6-Year Experience Hiroaki Sasaki, MD, Hitoshi Ogino, MD, Hitoshi Matsuda, MD, Kenji Minatoya, MD, Motomi Ando, MD, Soichiro Kitamura, MD The Annals of Thoracic Surgery Volume 83, Issue 2, Pages S805-S810 (February 2007) DOI: 10.1016/j.athoracsur.2006.10.094 Copyright © 2007 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 Refinement of cardiopulmonary bypass (CPB), brain protection, and body (core) temperature (BT). (FA = femoral artery; Asc.Ao = ascending aorta; AxA = axillary artery; SCP = antegrade selective cerebral perfusion; RCP = retrograde cerebral perfusion.) The Annals of Thoracic Surgery 2007 83, S805-S810DOI: (10.1016/j.athoracsur.2006.10.094) Copyright © 2007 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 A two-pump system for cardiopulmonary bypass (CPB) and antegrade selective cerebral perfusion (SCP). The Annals of Thoracic Surgery 2007 83, S805-S810DOI: (10.1016/j.athoracsur.2006.10.094) Copyright © 2007 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 Integrated total arch replacement using antegrade selective cerebral perfusion with right axillary artery perfusion. (1) Arch or distal arch aneurysm. (2) Ascending aorta and right axillary artery cannulation for cardiopulmonary bypass. (3) Induction of hypothermic circulatory arrest with the arch vessels clamped. (4) Selective cerebral perfusion with right axillary artery, left common carotid artery, left subclavian artery perfusion. (5) Original stepwise technique. (6) Refined stepwise technique with mini-elephant trunk. (7) Distal anastomosis. (8) Graft-to-graft anastomosis. (9) Total arch replacement using quadrifurcated graft. Circled numbers show the turn of the anastomosis. The Annals of Thoracic Surgery 2007 83, S805-S810DOI: (10.1016/j.athoracsur.2006.10.094) Copyright © 2007 The Society of Thoracic Surgeons Terms and Conditions

Fig 4 Mid-term survival (Kaplan-Meier estimates). The Annals of Thoracic Surgery 2007 83, S805-S810DOI: (10.1016/j.athoracsur.2006.10.094) Copyright © 2007 The Society of Thoracic Surgeons Terms and Conditions