Aortic Arch Replacement with Retrograde Cerebral Perfusion Performed Twice in the Same Patient to Resolve an Aortic Dissection

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Abstract

A 71 year old man was referred to our hospital for aortic arch dissection (Shumway type A). He underwent emergency aortic arch replacement with a 26 mm low porosity dacron graft under deep hipotermia, circulatory arrest and retrograde cerebral perfusion via the superior vena cava for 55 minutes. There was no neurological deficit. When the patient developed postoperative aortic graft infection a second aortic arch replacement was performed using the same method. Due to the inavailability of an aortic homograft, another 26 mm dacron graft was used. The left rectus abdominis muscle was anchored around the graft to completethe procedure. The blood supply to this muscle was conserved by the epigastric artery. The procedure was successful and the patient was discharged from the hospital 15 days later. After seven months of follow-up, the patient is in good clinical condition and has no evidence of infection.