Surgical technique:
In the cases of ascending aorta, aortic arch, and aortic root replacement, the chest was opened via a median sternotomy under general anesthesia. The bilateral axillary arteries were exposed for arterial cannulation. Cardiopulmonary bypass (CPB) was established with bilateral axillary arterial cannulation and bicaval drainage. The patient’s body temperature was cooled down to 25°C and measured rectally, followed by implementation of lower body circulatory arrest with moderate hypothermia. Antegrade selective cerebral perfusion was established by axillary perfusion with clamped brachiocephalic and left subclavian arteries and by direct cannulation of the left common carotid artery. Antegrade cold blood cardioplegia was administered to achieve and maintain cardiac arrest. Open distal anastomosis was first performed. The arch vessels were reconstructed individually, and finally, proximal anastomosis was completed.
In the cases of descending aorta and thoracoabodominal aorta replacement, the chest was opened via a intercostal space under general anesthesia.The femoral artery and vein were exposed for cannulation. CPB was established with the arterial cannulation and right ventricular drainage via femoral vein. If possible, anastomosis was performed by aortic clamping with normal temperature. If not possible, the patients’ body temperature was cooled down to 25°C, mesured rectally, followed by the implementation of lower body circulatory arrest with moderate hypothermia. Open proximal and distal anastomosis were performed.