To summarize the management of cardiopulmonary bypass (CPB) in total aortic arch replacement procedure with two diffirent methods of antegrade selective cerebral perfusion (aSCP).

Seventy-eight patients with Standford A aortic dissection were subjected to total aortic arch replacement procedure in 2016 in our department. According to the different aSCP methods, the patients were devided into two groups: conventional group (single aSCP) and modified group (aSCP combined with distal perfusion). The general data, CPB time, aortic clamp time, auxiliary circulation time, circulation arrest and brain-perfusion time, postoperative awake time, tracheal intubation time, ICU stay time, blood transfusion, postoperative complications, thoracic mediastinal drainage and postoperative hospital time were recorded.

There were 3 cases of postoperative death in the conventional group while there was no death in the modified group. There was no significant difference in the mean CPB time [(239.45±48.78) min vs. (233.69±53.61) min] and the mean arotic clamp time [(131.73±24.05) min vs. (148.77±39.81) min] (P=0.161, 0.050). Moreover, the modified group was significantly better than the conventional group in ostoperative awake time [(42.65±9.67) h vs. (30.43±8.34) h], ventilation time [(58.82±12.90) h vs. (46.33±11.82) h], ICU stay time [(6.48±1.08) h vs. (5.80±0.94) h], blood transfusion [1 203.25±242.91) ml vs. (953.33±127.43) ml], postoperative complications, thoracic mediastinal drainage [827.16±239.80) ml vs. (688.00±85.62) ml] and postoperative hospital time [23.95±1.94) days vs. (18.80±2.11) days] (P=0.029, 0.050).

ASCP combined with distal perfusion, through the right subclavian artery, showed clearly advantage in the clinic outcome compared to single aSCP in the treatment of aortic dissection.

Cardiopulmonary bypass; Aortic dissection; Brain protection; Distal perfusion