Open Hybrid Treatment of Complex Type A Aortic Dissection With Occluded Right Carotid Artery

F. Stembal¹, M. Koprivanac^2
1Department of Thoracic and Cardiovascular Surgery, Heart, Vascular and Thoracic Institue, Cleveland Clinic Foundation, Cleveland, Ohio ²Department of Thoracic and Cardiovascular Surgery, Heart, Vascular and Thoracic Institute, Cleveland Clinic Foundation, Hunting Valley, Ohio

Please explain the educational or technical point that this video addresses.: This video presents technical details and considerations for a hybrid aortic repair in a setting of acute type A aortic dissection. Organ malperfusion is one of the well-known complications associated with acute aortic dissections and demands active management in order to achieve favorable patient outcomes. We demonstrate a technique of central aortic cannulation and hybrid repair of the aortic arch using stent placement in all three supra-aortic vessels as a fast and feasible option for acute aortic dissection repair and malperfusion alleviation.

Please provide a 250 word summary of the surgical video being submitted.: This is a case of a 60-year-old patient with a complex acute type A aortic dissection, including a fixed occlusion of the right common carotid artery who presented with loss of consciousness and chest pain. The patient underwent emergent surgery at our institution which consisted of aortic valve resuspension, replacement of ascending aorta, and a hybrid total arch replacement with a frozen elephant trunk BSAFER procedure. We demonstrate a technique of central aortic cannulation as a feasible option in the emergent setting of acute type A dissection. Furthermore, we present our hybrid approach to aortic arch repair. During this procedure, three additional stents were placed in the true lumen of each of the supra-aortic vessels. We emphasize our approach to the innominate artery and the decision-making process for additional stent placement in the right common carotid artery in the setting of a fixed occlusion. The patient's postoperative course was uneventful, with complete neurological recovery. We suggest a hybrid approach to the aortic arch repair as a feasible option in the emergent setting of acute type A aortic dissection.