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Eur J Cardiothorac Surg 2006;29:611-612
© 2006 Elsevier Science NL

How-to-do-it

A hybrid technique of aortic arch branch transposition and antegrade stent graft deployment for complete arch repair without cardiopulmonary bypass

Department of Cardiac Surgery, Austin Hospital, Studley Road, Heidelberg, Melbourne, Vic. 3084, Australia

Received 22 September 2005; received in revised form 8 December 2005; accepted 16 December 2005.

^_* Corresponding author. Tel.: +61 3 9457 1071; fax: +61 3 9457 6320. (Email: gmatalan{at}bigpond.net.au).

We describe a minimally invasive technique for complete aortic arch repair without cardiopulmonary bypass. A 77-year-old man with severe obstructive airways disease presented with aneurysmal disease of his aortic arch. Through a median sternotomy and the application of a side-biting clamp, the common trunk of a bifurcation Dacron graft was anastomosed to the ascending aorta. The limbs of the graft were anastomosed to the innominate and left common carotid arteries, respectively. The left subclavian artery was ligated. Two endoluminal stent grafts were deployed via a side arm in the Dacron graft, covering the whole arch. Completion angiography and transesophageal echocardiography revealed excellent seating of both stent grafts, with no endoleaks. The patient had a rapid, uneventful post-operative recovery. Follow-up CT scanning revealed complete exclusion of the arch aneurysm.

Key Words: Aneurysm • Aortic arch • Off-pump • Stent graft

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