One advice to the decision of graft size for ascending and total arch graft replacement (in a case of differential diameters in ascending aorta and descending aorta)

We carried out the surgery of thoracic aortic aneurysm in fifty-eight patients from June 1994 to February 1999 (including aortic dissection in twenty-six patients). The mean size of grafts were 28.1 mm in ascending graft replacement, 25.8 mm in both ascending and arch graft replacement and 23.8 mm in descending graft replacement. The grafts for ascending aortic aneurysm were significantly larger than those for descending aortic aneurysm. In two of twenty-six patients undergoing both ascending and arch graft replacement, different size of grafts were used for ascending replacement and for arch replacement with satisfactory results in terms of bleeding from the anastomotic sites. Case 1; A 45-year-female with aortitis syndrome and aortic regurgitation due to annuloaorticectasia and thoracic aortic aneurysm underwent simultaneous aortic root replacement with composite graft (25 mm St. Jude Medical valve and 28 mm Hemashield graft) and total arch replacement (30 mm Hemashield graft with two side branches). Case 2; A 64-year-female was diagnosed as chronic type II dissecting aneurysm combined with acute type I aortic dissection. Ascending aorta was replaced with a 26 mm Hemashield graft, and the aortic arch was replaced with a 24 mm Hemashield graft with three side branches.