Purpose: To achieve good outcomes during aortic surgery with circulatory arrest, a secure and non-bleeding anastomosis must be achieved rapidly to ensure brain protection. We report our initial experiences with a modified Branched Graft Inverting (BGI) technique using an inserter under mild hypothermia. We aimed to reduce the surgical duration and to prevent unnecessary damage to the fragile aorta. Methods: We retrospectively reviewed patients with type A acute aortic dissection (AAD) who underwent distal anastomosis via the modified BGI technique using an inserter between January 2012 and March 2013. Open distal anastomosis was performed under mild hypothermia with right hemisphere perfusion from the right axillary artery. Results: Eight patients were enrolled. There was no mortality. Circulatory arrest time was reproducibly 20.3 ± 1.9 min, which was sufficient to complete non-bleeding distal anastomoses. The average rectal temperature during circulatory arrest was 26.5℃ ± 1.9℃. All patients were extubated the day after the operation without any neurological deficit. Conclusion: The modified BGI technique employing an inserter and mild hypothermia offered easy, secure, and reproducible distal anastomosis for ascending aortic replacement for type A acute aortic dissection. Our outcomes were favorable and support further development of this technique.
Cite this paper
Kawabori, M. , Murakami, T. , Ahn, K. , Kato, Y. , Kotani, M. and Toyama, M. (2014) A Modified Branched Graft Inversion Technique Employing a Syringe Inserter in Ascending Aortic Replacement for Type A Aortic Dissection. World Journal of Cardiovascular Surgery
, 95-100. doi: 10.4236/wjcs.2014.47015
 Kawahito, K, Adachi, H, Yamaguchi, A. and Ino, T. (2001) Preoperative Risk Factors for Hospital Mortality in Acute Type A Aortic Dissection. The Annals of Thoracic Surgery, 71, 1239-1243. http://dx.doi.org/10.1016/S0003-4975(00)02654-0
 Ehrlich, M.P., Ergin, M.A., McCullough, J.N., Lansman, S.L., Galla, J.D., Griepp, R.B., et al. (2000) Result of Immediate Surgical Treatment of All Acute Type A Dissections. Circulation, 102, 248-252. http://dx.doi.org/10.1161/01.CIR.102.suppl_3.III-248
 Kamiya, H., Hagl, C., Kropivnitskaya, I., Weiderwann, J., Kallenbach, K., Haverich, A., et al. (2007) Quick Proximal Arch Replacement with Moderate Hypothermic Circulatory Arrest. The Annals of Thoracic Surgery, 83, 1055-1058. http://dx.doi.org/10.1016/j.athoracsur.2006.09.085
 Hata, M., Suzuki, M., Sezai, A., Niino, T., Yoshitake, I., Minami, K., et al. (2008) Less Invasive Quick Replacement for Octogenarians with Type A Acute Aortic Dissection. The Journal of Thoracic and Cardiovascular Surgery, 136, 489-493. http://dx.doi.org/10.1016/j.jtcvs.2008.01.007
 Sabik, J.F., Lytle, B.W., Blackstone, E.H., McCarthy, P.M., Loop, F.D. and Cosgrove, D.M. (2000) Long-Term Effectiveness of Operations for Ascending Aortic Dissections. The Journal of Thoracic and Cardiovascular Surgery, 119, 946-962. http://dx.doi.org/10.1016/S0022-5223(00)70090-0
 Cook, R.C., Gao, M., Macnab, A.J., Fedoruk, L.M., Day, N. and Janusz, M.T. (2006) Aortic Arch Reconstruction: Safety of Moderate Hypothermia and Antegrade Cerebral Perfusion during Systemic Circulatory Arrest. The Journal of Cardiovascular Surgery, 21, 158-164.
 Hata, M., Sezai, A., Yoshitake, I., Wakui, S., Takasaka, A., Minami, K. and Shiono, M. (2010) Clinical Trends in Optimal Treatment Strategy for Type A Acute Aortic Dissection. Annals of Thoracic and Cardiovascular Surgery, 16, 228-235.
 Hata, M., Suzuki, M., Sezai, A., Niino, T., Yoshitake, I., Shimura, K. and Minami, K. (2009) Outcome of Less Invasive Proximal Arch Replacement with Moderate Hypothermic Circulatory Arrest Followed by Aggressive Rapid Re-Warming in Emergency Surgery for Type A Acute Aortic Dissection. Circulation Journal, 73, 69-72. http://dx.doi.org/10.1253/circj.CJ-08-0499
 Ishikawa, N., Omoto, T., Miyauchi, T., Oi, M., Fukuzumi, M. and Tedoriya, T. (2012) Simple and Safe Graft Insertion in the Elephant Trunk Technique. Asian Cardiovascular and Thoracic Annals, 20, 356-357. http://dx.doi.org/10.1177/0218492311436121