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A 69-year-old female presented with increasing shortness of breath (NYHA class II) and was previously followed for aneurysmal dilatation of her thoraco-abdominal aorta with a chronic type B aortic dissection. Repeat computed tomography (CT) demonstrated severe dilatation of her ascending aorta, aortic arch, descending aorta, and thoraco-abdominal aorta with the chronic type B aortic dissection extending from the proximal descending thoracic aorta to the renal arteries. Pre-operative transthoracic echocardiography revealed moderate central aortic insufficiency with a dilated aortic root and ascending aorta. Other past medical history included an ongoing 50-packyear smoking history, chronic obstructive pulmonary disease, and remote cholecystectomy. We performed a pre-operative left carotid-subclavian bypass before aortic arch reconstruction, in order to facilitate more proximal arch anastomosis and shorten circulatory arrest times (1). The patient was subsequently brought to the hybrid operating room, where we describe the hybrid arch frozen elephant trunk reconstruction performed with aortic valve-sparing operation using the reimplantation technique.

Aortic valve sparing and hybrid arch frozen elephant trunk repair for mega-aortic syndrome