Re-implantation Valve-Sparing Aortic Root, Total Arch Replacement, Stented Graft Implantation and CABG

  • Cangsong Xiao
  • Yang Wu
  • Weihua Ye

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This video starts with an explanation of preoperative assessment, anesthetic management, and surgical preparation. Key steps of the procedure are precisely illustrated. This is followed by a demonstration of a valve-sparing aortic root, total arch replacement and stented graft implantation as well as coronary artery bypass grafting for a patient with chronic DeBakey Type I dissection and severe aortic insufficiency and coronary artery disease. The video aims to familiarize the practitioners with the whole process, thereby increasing confidence of surgical success.

Introduction

Open aortic arch surgery and coronary artery bypass grafting (CABG) are considered high-risk operations. Simultaneous operation is also associated with prolonged duration of myocardial ischemia and CPB, thus, proper perfusion strategies and myocardial protection contribute to successful outcomes. This video presents a 52-year-old female patient suffering from shortness of breath during exertion for 10 years. She was diagnosed with ascending aorta dilatation without previous surgical treatment. Pre-operative CTA showed DeBakey type I dissection and ascending aorta aneurysm, together with 80% proximal right coronary stenosis. The surgical plan includes cardiopulmonary bypass set up, “arch first” reconstruction with a four-branched-graft stented graft implantation into descending aorta and anastomosis and re-implantation aortic valve-sparing procedure. Post-operative CTA showed normal aortic root and arch and thrombus formation in false lumen at the level of stent. The patient is discharged uneventfully.

About the Author

Cangsong Xiao

Professor Cangsong Xiao is the chief professor of Department of Cardiac Surgery in Chinese PLA General Hospital, Beijing, China.

 
Yang Wu

Professor Yang Wu is professor of Department of Cardiac Surgery in Chinese PLA General Hospital, Beijing, China.

 
Weihua Ye

Professor Weihua Ye is professor of Department of Cardiac Surgery in Chinese PLA General Hospital, Beijing, China.

 

About this video

Author(s)
Cangsong Xiao
Yang Wu
Weihua Ye
DOI
https://doi.org/10.1007/978-981-15-0159-3
Online ISBN
978-981-15-0159-3
Total duration
14 min
Publisher
Springer, Singapore
Copyright information
© Springer Nature Singapore Pte Ltd. 2019

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Video Transcript

[MUSIC PLAYING]

This video demonstrates a valve-sparing aortic root and total arch replacement and stented graft implantation and coronary artery bypass grafting for a patient with chronic DeBakey type I dissection and severe aortic insufficiency and coronary artery disease.

This is a 52-year-old female patient. The patient suffered from shortness of breath on exertion 10 years ago. She was diagnosed as ascending aorta dilatation, but she didn’t receive surgery. Preoperative TTE showed severe aortic valve regurgitation and normal leaflets.

Preoperative CTA showed DeBakey type I dissection and ascending aorta aneurysm, and its diameter was 65 millimeters– and 80% proximal right coronary stenosis.