Combined heart transplantation and replacement of atheromatous proximal arch

Concomitant surgery on the aortic arch with hypothermic cardiac arrest in the setting of heart transplantation (HTX) is extremely rare. A 67-year-old woman who suffered from ischemic cardiomyopathy was evaluated for HTX. Computed tomography showed diffuse soft and hard atheromatous plaques of the entire aorta. Upon allocation of an appropriate donor organ, the ascending aorta and the proximal aortic arch were replaced using hypothermic cardiac arrest at 28℃ prior to arrival of the donor heart and without clamping of the diseased recipient aorta. After uncomplicated postoperative course the patient was recovered without neurological complications.