SELECTION OF OPERATIVE ADJUNCT FOR TRUE AORTIC ARCH ANEURYSM

We have operated upon 18 cases of true arch aneurysm, including 2 cases of rupture, in a recent 6 years and 3 months. Seventeen aneurysms were arteriosclerotic and one was syphilitic. Operative adjuncts during aortic cross clamping were left heart bypass with a centrifugal pump (LHB, 4 cases), retrograde cerebral perfusion (RCP, 5 cases) and selective cerebral perfusion (SCP, 9 cases). LHB was applied to localized aneurysm apart from the left subclabina artery. It was safely conducted during operation, but cerebral embolism happened in 2 cases by aortic cross clamping, leading to one hospital death. RCP was carried for emergency cases by rupture or inpending rupture. Recent three cases was operated on by left thoracotomy under RCP. SCP was conducted in 9 cases of large aneurysm, including 6 cases of total arch replacement. There was two operative deaths, but minimum complications in the survivors. Operative adjunct was selected by condition of true arch aneurysm, but we have thought that SCP was safely applied among these adjuncts.