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Background: Open distal graft to proximal aortic arch anastomosis is central to a hemiarch replacement. Even if the ischemic tolerance time of several organs during circulatory arrest (CA) at normothermia is much longer than that of the brain, very little is known about the safety and clinical efficacy of moderate hypothermia for organ protection during the average duration of CA needed for aortic arch replacement. Hemiarch replacement using the standard techniques of deep hypothermia and antegrade perfusion has often ignored the effects of prolonged distal body CA. Maintenance of distal organ, especially the liver and kidney, perfusion reduces the risk of postoperative renal dysfunction and coagulopathy., Case Presentation: A 72-year-old female patient was referred to our institute due to chest discomfort. Radiologic investigations revealed a giant aneurysm of the ascending aorta extending but confined to the proximal aortic arch. We performed an alternative technique for hemiarch replacement using a dual inflow source., Conclusions: Although this technique cannot apply to all aneurysmal aortic diseases, our basic technique involving the use of dual inflow may be well suited for standard hemiarch replacement that is confined to the proximal aortic arch, given the shortening of the bypass and ischemic times.

We report a case of advanced aortic sinus aneurysm without the aggravation of aortic valve regurgitation after a simple reduction procedure for dilated aortic root base and sinotubular junction (STJ) in a Marfan patient with annuloaortic ectasia and severe aortic valve regurgitation. The aortic valve competence was well preserved by limited change of distances among the interleaflet triangles after reduction of the dilated aortic root base and STJ in the Marfan patient, although the sinus dilatation was aggravated.