Abstract
T he simultaneous operation of aortic arch repair (AAR) and coronary artery bypass grafting has been associated with considerable operative morbidity and mortality. This combined procedure has been considered inevitable, with prolonged myocardial ischemia and cardiopulmonary bypass (CPB) time, which are significant risk factors for adverse outcome in aortic arch surgery. Appropriate myocardial protection is also mandatory to avoid perioperative myocardial failure. Recent technical improvements in off-pump coronary artery bypass (OPCAB) encouraged us to introduce OPCAB into this simultaneous operation to minimize the period of myocardial ischemia and CPB for improved surgical outcome in these patients with multiorgan arteriosclerosis.
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