Total replacement of the ascending aorta without XXXX .

@entity1 @entity1779 @entity1167
OBJECTIVE: If the aortic arch is clamped between the brachiocephalic trunk and the left common carotid artery and the brachiocephalic trunk is also clamped, the total ascending aorta can be replaced without @entity1167 . Candidates for this technique need to have the following characteristics: preoperative demonstration of Willis polygon patency by means of transcranial Doppler ultrasonography, preoperative computed tomographic scan that shows no calcification in the arch or in the brachiocephalic trunk, and preoperative or intraoperative evidence of separate origins of the brachiocephalic trunk and the left common carotid artery. METHODS: In three different institutions (with different time frames in each) from December 2000 to December 2001, the possibility of replacing the total ascending aorta without @entity1167 was evaluated in 14 cases. In 10 of them it was possible (feasibility of 71.4%). During the procedure continuous electroencephalographic monitoring was performed. RESULTS: No @entity1 died in the early or midterm follow-up. None of the @entity1 had any cerebral complications. The electroencephalographic activity was normal during the period of brachiocephalic trunk occlusion. In 5 @entity1 a postoperative spiral computed tomographic scan showed good surgical results. CONCLUSIONS: The technique described here allows replacement of the total ascending aorta without @entity1167 in selected cases. Furthermore, the evidence of lack of right @entity1779 in all the procedures we performed allows future exploration of the possibility of avoiding cerebral monitoring.
