Transverse aortic arch aneurysm: improved results of treatment employing new modifications of aortic reconstruction and hypothermic cerebral circulatory arrest.

The results of graft replacement for aneurysms involving the entire transverse aortic arch have lagged far behind that achieved for similar lesions located elsewhere. For example, prior to the study reported here, the mortality rate of the former, in our experience, was 25%, whereas it was only 8% for the most extensive forms of thoracoabdominal aortic aneurysms. The difference had been due to limitations and complications of methods employed for cerebral and myocardial protection. The high mortality rate in our patients was due to the deficiencies of temporary bypass graft and cardiopulmonary bypass, and separate brachiocephalic perfusion employed for this purpose. This report is concerned with the use of profound hypothermia for cerebral protection and the application of graft inclusion and direct brachiocephalic arterial reattachment to prevent bleeding in region of operation, as so successfully employed in patients with thoracoabdominal aortic aneurysms. The entire thoracic aorta was involved in four patients, the aortic valve in two patients, coronary artery bypass was performed in two patients, and the pulmonary artery was obstructed in one patient. Employing the techniques described in this report, all eight patients with these extensive lesions survived without complication.