Ruptured Aortic Aneurysm of the Arch and Ascending Aorta

Symptomatic posterior contained rupture of a 70mm aortic aneurysm of the ascending aorta and proximal arch. Moderate aortic valve regurgitation with a central jet due to dilatation of the sino-tubular junction (STJ) and adjacent valve commissures. Tri-leaflet aortic valve. Surgical repair performed via sternotomy and right femoral artery and vein cannulation for cardiopulmonary bypass. Steps: 1) innominate artery de-branching using a trifurcate aortic arch woven dacron graft with a perfusion side-arm. 10mm graft limb used.Then head perfusion commenced from the heart-lung machine via the graft side-arm. 2) left common carotid artery de-branched, using the 8mm limb of the aforementioned graft. 3) clamping of distal aortic arch, aneurysm opened and the heart arrested with Del Nido cardioplegia 4) cooling to 26 degrees Centigrade 5) aortic arch transected between innominate and left common carotid artery; aorta replaced with a 26mm woven dacron graft 6) aortic graft then sutured to sino-tubular junction 7) 10mm arch graft attached to 26mm aortic graft end-to-side Video is obtained using head-mounted Parallel Medical Camera: www.parallel-medical.com