A novel arch-first T-graft technique for extensive aortic arch reconstruction

To reduce the morbidity and mortality associated with extensive aortic arch replacement, the reconstruction technique is the most important part of the treatment. By refining the present techniques, we developed an arch-first T-graft technique. This technique provides a more reasonable arrangement of procedures, least brain ischemic time, less low-body ischemic time, and an easy way of distal aortic anastomosis. This method is performed through a traditional median sternotomy, keeps the lung free from manipulation, and avoids severe kink of major vascular grafts.