Purpose. Conventional surgical therapy of aortic arch aneurysms consists of aortic arch replacement requiring cardiopulmonary bypass and deep hypothermic circulatory arrest. This method is associated with significant morbidity and mortality, mainly due to neurologic complications and the sequelae of deep hypothermic circulatory arrest. Thus, it makes sense to work on developing less invasive surgical techniques.Description. Surgical aortic arch de-branching is required before the supra-aortic vessels can be safely covered by an endovascular stent graft. We describe how the supra-aortic vessels can best be revascularized, followed by complete coverage of the aortic arch with endovascular stent grafts.Evaluation. We hereby present our case selection criteria, preoperative work-up, and surgical approach for aortic arch de-branching with supra-aortic revascularization, followed by complete coverage of the aortic arch by endovascular stent grafting. This technique's safeguards and pitfalls are described for a cohort of 26 patients. We now describe how the BT and LCCA can best be revascularized, followed by complete coverage of the aortic arch with ESGs. Conclusions. Endovascular aortic arch repair after aortic arch de-branching has Technique PatientsWe performed EVAAR after aortic arch de-branching in 26 patients. We chose the endovascular approach over conventional aortic arch replacement with cardiopulmonary bypass (CPB) and deep hypothermic circulatory arrest in selected patients considered at high-risk due to multiple comorbidities and advanced age (Fig 1). Aortic arch pathology consisted of an aneurysm in 15 cases, and 6 patients presented a previous aortic dissection with development of an aortic arch aneurysm. A penetrating ulcer in the aortic arch was the underlying pathology in five cases. The ethics committees approved the study and waived the need for patient consent. Arch Vessel RevascularizationSurgery was initiated with an upper right, L-shaped, hemi-sternotomy to the third or fourth intercostal space. After exposing the ascending aorta, the supraaortic vessels were dissected and the innominate vein was encircled. Then the ascending aorta was tangen-

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Release patterns of cTnI and cTnT after CABG are different: cTnI reaches its postoperative peak value earlier and declines more quickly than cTnT. After uncomplicated CABG, serum levels of both cardiac troponins remain continuously low. Elevated concentrations reflect perioperative myocardial ischemia or infarction. CTnT shows a different release pattern in patients with or without myocardial infarction.

CTnI after minimal invasive surgery shows a characteristic pattern with a maximum at 24h after the operation. The measurement of postoperative biochemical marker concentrations, specially cTnI, reflects myocardial injury incurred during the procedure. It is an accurate method for confirming or excluding a perioperative myocardial injury diagnosis after OPCAB surgery.

Monitoring spinal cord function during surgical and endovascular interventions on the thoracic and thoracoabdominal aorta is necessary. It can be made more effective by precisely analyzing the interference factors of the neurophysiological monitoring method itself. Successful strategies of immediate troubleshooting could be identified.