Less invasive quick replacement of the proximal arch with aggressive rapid rewarming for type A acute aortic dissection.

We describe a newly modified technique, which we term "less invasive quick replacement" (LIQR) for type A acute aortic dissection (AAD). After cooling to a rectal temperature of 28 degrees C without any cerebral perfusion, circulating blood in the cardiopulmonary bypass (CPB) circuit was warmed up to 40 degrees C during open distal anastomosis. As soon as the distal anastomosis was completed, rapid rewarming was initiated by perfusing blood at 40 degrees C. The average CPB and total operative times were 71.8 +/- 9.6 and 130.6 +/- 7.7 min, respectively. The shortest operative time was 101 min from skin incision to skin closure. All patients were weaned off the ventilator within 12 h of surgery. The postoperative hospital stay was 9.3 +/- 1.2 days. There was no incidence of cerebral damage or hospital mortality. Our initial results showed LIQR to be safe and effective.