Abstract: Objective To assess the effect of normothermic arch-first technique without extracorporeal circulation in total aortic
arch replacement for management of acute Stanford type A dissection. Methods The surgical data were reviewed for 23
patients (age range 32-58 years) with Stanford type A dissection undergoing total aortic arch replacement with the arch-first
technique in our department between January, 2006 and November, 2011. During the surgery, a 4-branched prosthetic graft
was connected with the inflow tube and femoral artery using the Y-type tube. The 3 aortic branches were disconnected and
anastomosed to the respective branches of the graft, with continuous perfusion of the brain by femoral arterial return. After
clamping of the ascending aorta, the graft was connected to the remaining arch before the common stem of the graft was
anastomosed with the aortic root. Results The operations were successfully completed in all the 23 cases with a mean total
bypass time of 187 ± 60 min (117-254 min), mean ascending aorta clamping time of 35 ± 8 min, and mean nasopharyngeal
temperature of 22±2 °C. Death occurred in one case (4.3%) after the operation, and 2 (8.7%) patients experienced temporary
neurological dysfunctions. The postoperative consciousness recovery time was 6-8 h in these cases. The shortest postoperative
mechanical ventilation time was 18 h, and 11 (48%) patients were weaned from mechanical ventilation within 48 h postoperatively.
The ICU stay ranged from 3 to 7 days in these cases. Conclusion Normothermic arch-first technique without extracorporeal
circulation can provide better brain protection and reduced the incidence of postoperative complications by shortening the
time of circulation bypass and aortic clamping.