Total Arch Debranching Technique for Hybrid in Zone 2

Arch debranching is a key component of hybrid total arch and ascending aorta replacement, allowing effective management of complex arch pathology while avoiding prolonged circulatory arrest. In this technique, following median sternotomy and cardiopulmonary bypass, the supra-aortic vessels (innominate, left common carotid, and often left subclavian artery) are individually revascularized using a multibranched Dacron graft originating from the replaced ascending aorta. This “debranching” creates a secure proximal landing zone for subsequent endovascular stent-graft deployment across the aortic arch. Cerebral perfusion is maintained throughout the procedure via selective antegrade cerebral perfusion, significantly reducing the risk of neurological injury. By combining open surgical replacement of the ascending aorta with endovascular exclusion of the arch, the hybrid arch debranching approach minimizes operative time, limits hypothermic circulatory arrest, and offers a durable solution for high-risk patients with extensive arch disease.