Safe Cerebral Protection: Reoperation Aortic Root and Proximal Arch Reconstruction

The patient is a sixty-eight-year-old man with a history of chronic aortic dissection 10 years prior to this operation, which was repaired. He had aortic regurgitation and required redo surgery. 

First, the right femoral vein was cannulated and the innominate artery and aorta were both cannulated separately so that the perfusion could be split. The cerebral flow was cooled to 20 °C while the aortic perfusion to the body was kept normothermic.

A pediatric cannula was then inserted into the innominate artery first, and flow commenced at 1 liter per minute. A clamp was then placed proximal to this cannula to isolate cerebral circulation. The remaining aorta was clamped and retrograde cardioplegia was given. The aorta was then opened and the ascending aorta was removed. The original false lumen was identified in the removal process so that the new graft could sit in the correct position. 

Next, the old graft was carefully removed so that a root replacement could be performed. The most difficult task was to free up the left main stem coronary artery, which must be done carefully and is demonstrated on the video. The right coronary button was also carefully created, the native valve was removed, and a root replacement was performed. The distal anastomosis was then created and the operation was completed with safe protection of the brain and protection from potential cerebral emboli throughout.

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