Total arch replacement through re-median sternotomy after coronary surgery

We report the case of 78-year-old-man who required graft replacement of an aortic arch aneurysm. He previously had undergone off-pump coronary artery bypass grafting with the right internal thoracic artery bypassed to the left anterior descending artery. For this difficult case, we successfully performed total arch replacement using selective antegrade cerebral perfusion through a re-median sternotomy without injuring the right internal thoracic artery, which was the only blood source for the left and right coronary arteries.