This is the case of a sixty-eight-year-old man who had an acute aortic dissection 10 years previously and had quite a small prosthetic aortic tube grafted onto a relatively large distal aorta. He presented with severe aortic regurgitation.
First, percutaneous femoral vein cannulation was performed and the innominate artery was cannulated with a 14 Fr cannula and 1 liter of cerebral flow was initiated. This permitted a clamp to be placed between the innominate and carotid arteries to allow replacement of the proximal arch. Next, the innominate vein and the aorta were clamped and cardioplegia was given. The previous Dacron tube graft was removed and then coronary buttons were created.
A KONECT bioprosthetic root replacement was then used to perform a root replacement and an open distal anastomosis was also performed.
This video is also available here as “Safe Cerebral Protection: Reoperation Aortic Root and Proximal Arch Reconstruction.”
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1 Comment
Vince, again a great case with the concept of dual cannulation and dual perfusion (brain+body).
When you were sewing the LC button, can you comment on what it you did was fold part of the aortic wall button as you were sewing that to the opening in the graft. I think that is an excellent manouver to minimize bleeding ( a “biological pledget” .