Surgical Technique
A 70-year-old woman was diagnosed with chronic aortic dissection.
Contrast-enhanced computed tomography (CT) demonstrated a type A aortic
dissection with a primary intimal tear in the ascending aorta. The
aortic diameters were 76mm in the ascending aorta and 74mm in the
descending aorta (Figure 1).
Elective surgery was performed via a median sternotomy. Cardiopulmonary
bypass was initiated via cannulation of the ascending aorta, right
atrium, and left ventricular vent. Hypothermic circulatory arrest was
induced at a rectal temperature of 25°C. Retrograde and antegrade cold
blood cardioplegia were administered intermittently. Antegrade cerebral
perfusion was injected into the three supra-aortic vessels. LSCA
reconstruction was performed before the distal anastomosis. First, the
origin of the LSCA was ligated by silk threads, which were then pulled
caudally for better exposure of the LSCA. By clamping the distal LSCA,
the anterior wall of the LSCA was incised longitudinally. Subsequently,
a 5-cm length graft, which formed a part of the 4-branched Dacron tube
graft (J graft Japan; Lifeline, Tokyo, Japan), was anastomosed to the
LSCA using 5-0 polypropylene sutures
(Figure
2-a). The LSCA was declamped, and antegrade cerebral perfusion to the
LSCA was ensured through the anastomosed graft (Figure 2-b).
Thereafter, distal anastomosis was performed by first inserting the 5-cm
graft as the elephant trunk, and the 4-branched graft was anastomosed to
the transected aorta. A proximal anastomosis was performed, and the
heart was restarted. The left common carotid and innominate arteries
were reconstructed. Finally, the graft anastomosed to the LSCA was
reconstructed (Figure 2-c). Postoperative CT showed antegrade flow to
the supra-aortic vessels (Figure 2-d).