| Summary: | This video starts with an explanation of preoperative assessment, anesthetic management, and surgical preparation. Key steps of the procedure are precisely illustrated. In a patient with emergent aortic dissection, an emergent valve-sparing procedure combined with total arch replacement and a stent graft implanted is presented with detailed interpretation. The video aims to familiarize the practitioners with the whole process, thereby increasing confidence of surgical success.There is a significant morbidity and mortality risk on surgical treatment of aneurysms and dissections involving the aortic arch and the descending aorta. For patients with DeBakey type I aortic dissections involving the aortic arch, there has been a focus of debate among cardiovascular surgeons on whether to perform a hemiarch replacement or total arch reconstruction. This video presents a 32-year-old male patient diagnosed with DeBakey type I dissection involving innominate and axillary artery. The surgical plan includes upper hemi-sternotomy and cardiopulmonary bypass set-up, "arch first' reconstruction with a four-branched-graft (Vascutek), aortic root mobilization and sub-annulus suture placement, re-implantation aortic valve-sparing procedure and stented graft implantation into descending aorta and anastomosis. A 28MM four-branched-graft was used for total arch replacement. 'Arch first' reconstruction was performed by sequential anastomosis of the three arch vessels with the branched-graft. Post-operative imaging showed a normal aortic root and arch.
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