Learning curve of arch-first technique analyzed by cumulative sum.

This study was undertaken to verify efficacy of the arch-first technique in the light of its learning curve. From April 2002 to September 2005, 10 consecutive elective cases of total arch replacement were retrospectively examined. The learning curve of the arch-first technique was constructed using cumulative sum analysis. There were no operative deaths. The mean deep hypothermic circulatory arrest time was 28.4 +/- 13.7 min, the lower body ischemic time was 91.3 +/- 35.1 min, aortic cross clamp time was 133.2 +/- 18.1 min, cardiopulmonary bypass time was 198.8 +/- 21.5 min, and operation time was 383 +/- 24 min. The durations of deep hypothermic circulatory arrest, bypass, and operation were under the 90% lower alarm line in all 10 cases. The lower body ischemic time and cardiac arrest time were between the 80% upper and lower alert lines. Cumulative sum analysis of total arch replacement using the arch-first technique showed satisfactory rates of improvement in reconstruction of the 3 arch vessels, cardiopulmonary bypass time, and overall mortality.