Proximalized Custom-Made Frozen Elephant Trunk for Aortic Arch Reconstruction

Aortic arch surgery is not a trademark. In turn, it practically translates to a collection of different, often surgeon-specific, techniques.

This step-by-step video outlines a simplified technical approach to the community. The key-points are as follows:

• Set unilateral antegrade cerebral perfusion at 28°C using a simplified brachiocephalic trunk cannulation without the need for extra incisions or time-consuming dissections.
• Perform the reconstruction of the supraaortic vessels prior to the aorta. This will give you more space and an excellent visual overview, which translates into better results.
• You can check all anastomosis sufficiently. This prevents some “bad surprises” after loosening the X-clamp and shortens the final check for bleeding.
• Use the aortic stent and aortic prosthesis separately. This facilitates the distal anastomosis because— once again—you have an excellent exposition and can place clear stitches.
• Reinsert the transposed supraaortic vessels as distal as possible. This facilitates a staged interventional procedure in the instance of concomitant distal aortic disease. Furthermore, it will give you enough space for cannulation and perfusion in case of redo surgery.

At the very least, the surgical technique is standardized and can be applied to nearly each pathoanatomy. A standardized approach always translates into quicker and better procedures.

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