[Surgical treatment for aortic arch aneurysm: newly developed procedures and their outcomes].

The surgical treatment of aortic arch aneurysm including newly developed procedures and their outcomes is reviewed. Major advances in aortic arch repair have been made by meticulous brain protection with antegrade-selective and retrograde cerebral perfusion in addition to hypothermia circulatory arrest and refinement of surgical techniques. Total arch replacement using a multibranched prosthetic graft with antegrade-selective cerebral perfusion (SCP) under hypothermia through a median sternotomy has been standardized, resulting in lower mortality and cerebral mortality rates. In particular, the impact of the use of the axillary artery for cardiopulmonary bypass and of the stepwise or elephant trunk technique for distal anastomosis has recently been assessed. In addition, arch repair under moderate hypothermia in conjunction with SCP has been attempted without any serious problems. The surgical strategy for extended aortic aneurysms is also of concern. A two-stage approach with an elephant trunk procedure is employed predominantly for high-risk patients, while one-stage repair is aggressively applied for relatively young, low-risk patients. In contrast, there has been great progress in stent graft therapy for aortic arch lesions. Arch stent graft repairs including hybrid procedures have been attempted in elderly, high-risk patients. Consequently, these comorbid procedures can be used satisfactorily.