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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.
- Cannulate the right axiliary artery.
- Resect the ascending aorta and aortic valve.
- Implant the stentless aortic bioprosthesis.
- Perform the proximal anastomosis of the vascular prosthesis at the level of the sino-tubular junction.
- Cool the patient to 26 °C and proceed with circulatory arrest.
- Clamp the innominate trunk.
- 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).
- Resect the aortic arch.
- Perform the distal anastomosis between the aorta and the vascular prosthesis.
- Cannulate through the perfusion branch of the vascular prosthesis.
- Re-start systemic perfusion.
- Perform one-by-one sequential anastomosis for the innominate trunk, left common carotid artery, and left subclavian artery.
- Remove the cannula.