At this point, a second arterial line is connected to the cannula previously placed into the fourth branch of Thoraflex. The antegrade blood flow is slowly restored to fill the abdominal and descending aorta. Once the prosthesis is completely full of blood, de-airing is done, and the proximal part of the prosthesis and its branches are clamped (figure 1). The full arterial flow is now slowly restarted to perfuse the lower body, and the patient progressively rewarmed. The distal anastomosis is performed between the incorporating sewing collar of the Thoraflex and the aorta, starting from the previously prepared 2 U-stitches (figure 2).
The supra-aortic vessels are anastomosed to the branches of the graft, and the operation is completed with an aortic root procedure if necessary.