Surgery for Type B Aortic Dissection – Fresh Elephant Trunk and Vascular Ring Connector

Operator : Jeng Wei, MD, MSD, Director of Heart Center, Cheng-Hsin General Hospital, Taipei, Taiwan.
1. Two 8 mm Dacron grafts anastomosed to right subclavian artery and one side common femoral artery before heparinization – heparinization – sternotomy – RA cannulation – CPB
2. Aortic clamp – infusion of HTK cardioplegia into aortic root – stop systemic perfusion – cerebral perfusion 1.2 liter/min through the right subclavian artery.
3. Incise the ascending aorta and proximal arch, not extending to the distal arch.
4. Insertion of guide wire from the femoral artery graft
5. Using the guide wire to pull the distal arm of the elephant trunk into the descending thoracic aorta.
6. The fresh elephant trunk was made of a 10-15 cm Dacron graft and an interposed titanic vascular ring connector (Vasoring) at the proximal arm. Tapes surrounding the aorta were used to tie the proximal arm of the elephant trunk against the aorta.
7. The proximal anastomosis is usually located between the left carotid artery and left subclavian artery. The left subclavian artery can be ligated or anastomosed to the left carotid artery if the blood pressure over the left upper limb was lower than 60 mm Hg after re-circulation.
8. Close the aortotomy without the need to remove air from the heart.
9. Heart ischemic time usually less than 30 minutes.