Novel Vascular Connector to Facilitate Arch Vessel Anastomosis During Open Arch Reconstruction

J. J. Kelly, C. R. Brown, W. Y. Szeto
University of Pennsylvania, Philadelphia, Pennsylvania

Please explain the educational or technical point that this video addresses.: Total aortic arch reconstruction is technically complex and requires a period of hypothermic circulatory arrest. Prolonged cerebral and body ischemia during circulatory arrest increases the risk for postoperative neurologic and end-organ dysfunction. Traditionally, anastomosis of the supra-aortic arch branch vessels to the aortic arch graft is performed with standard suturing techniques. However, this can be time consuming and technically challenging. This video illustrates the use of a novel vascular anastomotic device that facilitates more efficient supra-aortic arch vessel revascularization compared to conventional suturing technique in a total arch procedure. While the device can be utilized for both the left common carotid and left subclavian artery anastomoses, it is especially promising for the left subclavian, as this anastomosis is often more challenging based on its anatomic location. The objective of this video is to demonstrate the feasibility of supra-aortic arch branch vessel revascularization with this novel device, which may reduce cerebral and body ischemic time and postoperative neurologic and end-organ dysfunction.

Please provide a 250 word summary of the surgical video being submitted.: This video demonstrates the use of a novel vascular connector during a total arch procedure to illustrate how the device can facilitate the efficient anastomosis of the supra-aortic branch vessels. A 58-year-old male presented with dyspnea and was found to have severe aortic insufficiency, an aortic root aneurysm (5.6 cm) and descending thoracic aortic aneurysm (4.9 cm). Surgical plan was for elective aortic root replacement and total arch with frozen elephant trunk. Circulatory arrest was initiated at 28°C with ACP. After the arch was dissected out and trimmed to Zone 3, a hybrid arch frozen elephant trunk stent graft was deployed with distal anastomosis in Zone 3. The device was used to perform the left subclavian and left common carotid anastomoses. To use the device, the graft branch is trimmed to 3 cm. Two 4-0 polypropylene stay sutures are placed opposite each other at 9 and 3 o'clock through the native artery and the branch graft. The device is advanced through the branch graft and then 2 cm into the native artery. Tension is applied to the 2 stay sutures and the device is deployed. The device is removed, and the stay sutures are tied down. Following the completion of these anastomoses, cardiopulmonary bypass was reinitiated, and the innominate anastomosis was performed. Postoperatively, the patient was extubated and weaned off vasoactive medications on day 1. He was discharged home on post-op day 9. Discharge CT angiography showed patent left carotid and left subclavian anastomoses.