Aneurysm of the Ascending Aorta and Proximal Arch

Dr Cheng-Hon Yap shares this great video of a complex repair procedure performed on an asymptomatic, incidentally discovered 73mm Ascending Aortic Aneurysm involving the proximal arch of the aorta in a 65 year old lady. Severe aortic valve regurgitation due to dilatation of the sino-tubular junction (STJ) and adjacent valve commisures. Surgical repair performed via sternotomy and central cannulation for cardiopulmonary bypass. Procedural Steps: 1) innominate artery debranching using a 10mm dacron graft with 8mm side-arms, and head perfusion via heart-lung machine 2) clamping of ascending aorta, heart arrested with Del Nido cardioplegia 3) cooling to 23 degrees Centigrade, lower body circulatory arrest, clamping of left common carotid and left subclavian artery 4) aortic arch transected between innominate and left common carotid artery; distal aorta replaced with a 26mm dacron graft with 8mm side-arm 5) circulation to lower body restarted, and rewarming begun 6) STJ transected, 24mm dacron graft sutured here to remodel the STJ and replace proximal aorta 7) 26 mm - 24 mm grafts attached end-to-end 8) 10mm graft attached to 24mm graft end-to-side TOE subsequently showed a good aortic valve repair with no regurgitation and a coaptation height of 7mm. Patient did well needing no inotropic support post CPB. She was extubated 24 hours later and went on to make an uneventful recovery. Thank you to Dr. Cheng Hon Yap for sharing. The video is captured using the PARALLEL Medical camera (1080p, 60fps, -2/3EV).