A novel approach to reconstructing the distal aortic arch

Repair of the aortic arch remains one of the greatest challenges in cardiac surgery. This difficulty is compounded by associated descending or thoracoabdominal pathology. Options include single stage repair, two stage procedures and the ingenious elephant trunk operation where a distal trunk is left for reconnection at a subsequent operation or completion by endovascular stenting. We present a technique involving the use of horizontal interrupted buttressed sutures. This allows the distal suture line to be safely placed more distally than is generally the case, achieves reliable haemostasis and may avoid the need for a second stage procedure in some cases.