Abstract
Distal anastomosis during total arch replacement (TAR) for thoracic aortic aneurysm (TAA) is often difficult to perform because of the limited surgical view. The most common methods available are direct anastomosis of a 4-branched graft to the distal aorta, or stepwise anastomosis with the elephant trunk procedure. However, the stepwise technique requires graft-to-graft anastomosis, which is often associated with bleeding. In the present study, we developed a new approach, which we have termed the “Branched Graft Inversion technique”, which does not require anastomosis between grafts, and facilitates anastomosis with a view equal to that in the stepwise technique. A 65-year-old man with a diagnosis of saccular-type thoracic aortic aneurysm was admitted. Cardiopulmonary bypass was established by cannulating the ascending aorta and femoral artery via a median sternotomy. We performed distal anastomosis under selective cerebral perfusion during hypothermic circulatory arrest (25°C). An inverted branched graft was inserted into the descending aorta and anastomosed using mattress and running sutures together with outer reinforcement with a Teflon felt strip. The distal end of the inverted branched graft was then extracted, and reconstruction of the neck vessels and proximal anastomosis were performed. Our newly developed Branched Graft Inversion technique was useful during TAR for TAA.
