Arch-last technique for total arch replacement using two-pump system in Stanford type A aortic dissection

Methods Between June 2005 and December 2012, 22 patients (16 men and 7 women), aged 28 to 76 years(mean 56.7 ± 13.8), underwent total aortic arch replacement using antegrade selective cerebral perfusion through median sternotomy. Present pathologies were Stanford type A dissection (acute state in 19, chronic state in 3 patients), previous Bentall’s procedure in 3 and previous descending thoracic aortic repair in two patients. Operations were performed with antegrade cerebral perfusion through two options: with right axillary artery, left common carotid artery and left subclavian artery, or without the latter. After anastomoses of descending aorta and proximal ascending aorta operation were performed, the three neck vessels were each anastomosed during heart-beating with two pumps which were used for both cerebral and distal perfusion.