Open-branched stent graft placement makes total arch replacement easier for acute type a aortic dissection

In total arch replacement for acute type A aortic dissection, the left subclavian artery anastomosis and the distal anastomosis at the descending aorta are often remarkably difficult because of the deep surgical field. We developed a single-branched stent graft that was constructed by adding a side arm stent-graft to a conventional aortic stent graft. By its open placement into the origin of the left subclavian artery and the descending aorta, the left subclavian artery anastomosis could be avoided, and the distal aortic anastomosis was performed at the proximal arch between the brachiocephalic artery and the left common carotid artery.