Valve-sparing aortic root and partial aortic arch replacement with reimplantation of the brachiocephalic trunk for...

A 47-year-old female with dyspnoea, poor blood pressure control and a family history of aortic disease presented with chronic type IA aortic dissection (with a maximal aortic diameter of 50 mm at the ascending aorta level). Anatomically, the patient presented with involvement of the brachiocephalic trunk and the left renal artery originated from the false lumen. The aortic valve was trileaflet but demonstrated severe eccentric insufficiency. Due to this constellation of findings, urgent surgical repair was indicated. Cardiopulmonary bypass was established centrally by direct true lumen cannulation with Seldinger echo-guided technique and cross-clamping between the distal ascending aorta and the proximal aortic arch (zone 0) performed while cooling. A period of high-moderate hypothermic circulatory arrest (26°C core temperature) with bilateral selective antegrade cerebral perfusion was utilized to complete the distal reconstruction. To repair the morphologically normal trileaflet but severely regurgitant aortic valve prolapsing in the dissected aortic root a valve-sparing aortic root replacement (David procedure) was performed.