Intramural haematoma of the thoracic aorta. Aortic arch replacement + elephant trunk with antegrade selective cerebral perfusion and moderate hypothermia.

The video concerns a 48-year-old patient affected by acute aortic syndrome characterized by an intramural haematoma of the ascending aorta and aortic arch and a type B acute dissection who was referred to our hospital for surgical treatment.

The innominate artery was used as a site for CPB arterial inflow and right brain perfusion during circulatory arrest. Brain protection was achieved with bilateral antegrade selective cerebral perfusion and moderate hypothermia. The entire aortic arch was replaced with the separated graft technique using a prefabricated quadrifurcated collared graft. The surgical technique is shown in details.