Ten cases of transverse aortic arch replacement using antlers graft technique

Ten cases of total arch replacement were performed using the antlers graft technique. The patients consisted of 6 men and 4 women ranging in age from 34 to 76 years (mean: 62.1 years). These cases included 7 cases of Stanford type A acute aortic dissection and 3 cases of fusiform aneurysm of the aortic arch. During surgery we formed a composite graft (antlers graft) by attaching 10, 12 and 24 mm side branches to a 10 mm woven graft and under hypothermic circulatory arrest with retrograde cerebral perfusion (RCP), we first of all remodeled the neck vessels and re-established antegrade cerebral perfusion. We then remodeled the arch using another 24 mm graft and concluded surgery by anastmosing this graft to the antlers graft. Eighteen cases using the conventional technique, in which anastmosis is performed from the distal arch, needed 77 minutes on average for RCP. However, the antlers graft technique required only 46.2 minutes. Although 1 case each of cerebral complications was observed during both techniques, the antlers graft technique shortened the time required for emergence from the general anesthesia (4 hours vs 11.4 hours), the length of the stay in the ICU (6.0 days vs 7.3 days) and the total hospital stay (45.8 days vs 60.3 days), compared to the conventional technique.