[Clinical experience with normothermic selective cerebral perfusion during graft replacement of ascending-arch-descending aortic aneurysms with annuloaortic ectasia].

We treated three cases of ascending-arch-descending aortic aneurysm with annuloaortic ectasia by performing graft replacement. The patients included a 34 year old female, a 34 year old male and a 42 year old male. In one case the aneurysm was atherosclerotic and of type I and II + IIIb dissection in the other two cases. During the operation we were able to utilize normothermic selective cerebral perfusion during construction of the left common carotid artery. Specially, normothermic partial F-F bypass and normothermic selective cerebral perfusion to the left common carotid artery were used during graft replacement from the descending aorta to the left common carotid artery. This was followed by regular hypothermic total ECC and hypothermic cerebral selective perfusion during subsequent graft replacement of the innominate artery and a modified Bentall's operation. This new protocol in which normothermic cerebral perfusion is utilized during the procedure on the left common carotid artery and hypothermic perfusion is utilized only during the subsequent procedure on the innominate artery permits significant shortening of the cardiac arrest time and cerebral perfusion time compared with when only hypothermic perfusion is used. This significant shortening contains obvious benefits in the areas of cardiac and brain protection.