Atypical Arch Replacement

Recently, we experienced three atypical arch replacement cases. In these cases, we performed reconstruction of four arch vessels (because of anomaly of arch vessels). In such cases, it takes longer time for reconstruction of arch vessels. We used arch first technique with combined retro and partial-ante cerebral perfusion. Mean circulatory arrest time (including retrograde cerebral perfusion) was 44.3 +/- 4.1 (min),and Partial antegrade cerebral perfusion time was 21.5 +/- 2.1 min. Postoperative courses were good. And there were no cerebral complication. Arch first technique with combined cerebral perfusion was thought to be safe and effective (for good operative field) method for atypical arch replacement.