Freestyle Root With a Retroperitoneal Aortofemoral Bypass Graft

This patient had a severely calcified aorta with severe aortic regurgitation, calcified ascending aorta, and an occluded distal aorta with claudication.  

The aorta had to be cannulated at the back with an 18 Fr seldinger cannula due to a bank of calcium, and then the root was excised. It was measured on TEE as 17 mm, so a 21 mm porcine freestyle root was selected and sutured with 3.0 running Prolene. The buttons were calcified, but useable.  

A third incision was then made into the aortic root by opening both groins and passing fingers, then the instruments up the side of the femoral artery past the kidneys. Using a finger in the left chest down the aorta, a 7 mm Dacron graft was passed retroperitoneally and sutured from the aortic freestyle root to the femoral artery. Then, a second femoral-femoral graft was used to revascularize the patient’s legs.  

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