Total aortic arch replacement with a 4 branched Frozen Elephant Trunk (FET) Graft in Acute aortic dissection (De Bakey type I)

M. L. Shrestha
Mayo Clinic, Rochester, Minnesota

Please explain the educational or technical point that this video addresses.: 1.This video demonstrates the use of Frozen Elephant trunk graft in a patient with acute type A Aortic Dissection. It shows the use of Endoscope to control the stent graft in the true lumen of dissected descending aorta. This 'real time' control helps the surgeon to control the position of the FET stent.
2. This video also shows the continuous myocardial perfusion technique to reduce cardiac ischemia time during total aortic arch replacement.
3. This video also shows the valve sparing aortic rot replacement in AADA patient with root dilatation.

Please provide a 250 word summary of the surgical video being submitted.: After a median sternotomy, extra-corporeal circulation (ECC) was initiated with direct cannulation of the aorta (Seldinger technique under transesophageal echocardiography (TEE) guidance ) and the right atrium.
The left heart was vented through the right superior pulmonary vein.
Ascending aorta was cross-clamped and opened.
Cold blood cardioplegia (Buckberg) was given directly nto both the coronary ostia and was given every 30 minutes.
The patient was cooled down to a core temperature of 20°C.
Initially, valve sparing aortic root replacement with a straight tube graft ( David I Procedure) was performed.
Thereafter, the left ventricle was de-aired and the heart was perfused antegrade via a cannula in the ascending aortic graft.
Care was taken to keep the cardiac perfusion pressures below 80 mmHg.
Immediately after the start of the hypothermic circulatory arrest (HCA) and opening of the aorta,
the aortic arch was inspected in Trendelenburg position.
After isolation of the innominate artery (IA) and the left common carotid artery (LCCA) catheters were placed under direct vision into both the IA and LCCA and selective bilateral antegrade cerebral perfusion (SACP) was started.
The FET was deployed in the descending aorta.
After the distal anastomosis was completed (zone 2), an endoscope was used to control the position of the FET.
The perfusion to the lower part of the body was restarted via the fourth branch of the graft.
The supra-aortic vessels were anastomosed to the three branches of the arch graft.
After the normal body temperature is reached, the ECC was discontinued.