Total aortic arch reconstruction for multiple great vessel occlusive disease.

There were no differences in mortality or morbidity rates in the intrathoracic and extrathoracic groups treated at the Texas Heart Institute. Extrathoracic bypass did not seem to decrease morbidity. Early occlusion rates were similar for both groups. In cases of extrathoracic bypass, early and long-term patency depend on the diffuse nature of the disease, especially in the inflow artery. Surgical risk is not increased by intrathoracic direct revascularization, and the use of the aorta for proximal inflow may prolong patency. Results of revascularization of diffuse lesions of the great vessels produce results similar to those for revascularization of simple lesions of the internal carotid artery with regard to both intraoperative cerebral protection and excellent long-term patency. We have recently developed and refined minimally invasive techniques for exposure of the aorta and great vessels. These methods have allowed successful, simultaneous direct revascularization of multiple great vessels in cadaver and animal models. In selected patients with anatomically suited lesions, we plan to use these methods with goals of decreasing hospital stay and surgical risk while maintaining excellent long-term graft patency.