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Branch-First Arch Replacement: How to Do It

Thursday, November 13, 2025

By

Omar Jarral

Jarral OA, Pupovac S, Tseng A, et al. Branch-First Arch Replacement: How to Do It. November 2025. doi:10.25373/ctsnet.30593780

Branch-first arch replacement is a method for aortic arch repair that allows for continuous brain and organ perfusion. It theoretically has the potential for improved outcomes by reducing or avoiding circulatory arrest and maintaining warmer temperatures. 

This technique was pioneered by George Matalanis and others in  2005. This presentation focused on the technical aspects of this procedure, including a how-to video. 

References

  1. Matalanis et al. 2011 JTCVS
  2. Bakr et al. 2024 Journal of Cardiac Surgery

Disclaimer

The information and views presented on CTSNet.org represent the views of the authors and contributors of the material and not of CTSNet. Please review our full disclaimer page here.

Comments

Submitted by Omar Jarral on
One clarification. During this case, there is central cannulation only, no axillary cannula. During the graft to graft part, I place a pigsticker in the trifurcate graft, to perfuse brain until the circuits are united. This pig sticker is then used to deair. As an alternative, during the graft to graft, you can continue perfusion to the brain by keeping the third limb of the trifurcate graft, and perfuse via this.

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