Mini-Bentall Procedure and Hemiarch Replacement: Aortic Aneurysm Resection

In this video, the third in a seven-part series, Tristan Yan demonstrates how the proximal ascending aortic aneurysm is removed and the coronary buttons are prepared.

1. Under a low-flow condition, an atraumatic aortic cross-clamp is applied across the distal ascending aorta.
2. Diastolic arrest is achieved with antegrade Custodial cardioplegia delivered via a DLP aortic root cannula (Medtronic Inc, Minneapolis, MN, USA) and direct coronary ostial balloon tip cannula (Maquet Getinge Group, Rastatt, Germany) once the aorta is opened.
3. The aneurysmal segment of the ascending aorta is resected, leaving 1 cm cuff of aortic tissue proximal to the cross-clamp and 1 cm above the sinotubular junction. The right coronary button flap is prepared. Similarly, the left coronary button flap is also fashioned. Often only limited mobilization of the coronary buttons from the surrounding connective tissue is required.
4. In order to provide an excellent exposure, the aortic root is brought in a cephalad direction. This is achieved by putting a pledgeted 2-0 Ti-Cron horizontal mattress suture above each commissure.
5. These three commissural traction sutures are then hitched up to provide an excellent exposure of the aortic annulus with this minimal access setup.

View all videos in this series here.