Aortic Arch Debranching Technique: Total Aortic Reconstruction from the Aortic Valve to the Aortic Arch

The authors present the case of an 82-year-old woman with severe aortic valve stenosis and aneurysmal disease of the ascending aorta and aortic arch. The patient underwent a total aortic reconstruction from the valve through the distal arch. This video demonstrates the authors’ aortic arch debranching and reconstruction technique.

Steps:

1. Cannulate the right axiliary artery.
2. Resect the ascending aorta and aortic valve.
3. Implant the stentless aortic bioprosthesis.
4. Perform the proximal anastomosis of the vascular prosthesis at the level of the sino-tubular junction. 
5. Cool the patient to 26 °C and proceed with circulatory arrest.
6. Clamp the innominate trunk.
7. Perfuse the right carotid artery through the cannula placed in the right axillary artery (two separate cannulas will provide the perfusion of the left carotid artery and left subclavian artery).
8. Resect the aortic arch.
9. Perform the distal anastomosis between the aorta and the vascular prosthesis.
10. Cannulate through the perfusion branch of the vascular prosthesis.
11. Re-start systemic perfusion.
12. Perform one-by-one sequential anastomosis for the innominate trunk, left common carotid artery, and left subclavian artery.
13. Remove the cannula.