Surgical Technique
The patient is positioned with a sandbag under the left shoulder and
head turned towards the right side. The upper end of the sternal
incision is extended cranially to the left side of the neck over the
sternocleidomastoid muscle. With the neck turned to right side, this
extension is almost in line with median sternal incision. The sternal
head of the sternocleidomastoid is divided from its origin (Figure 1B)
enabling the exposure of the left common carotid artery (LCCA) and the
LSA. The aorta is then pulled caudally and the supra-aortic arch vessels
are dissected and looped. When the desired body temperature is reached,
the hybrid prosthesis is deployed in zone 2 and the supra-aortic arch
vessels are connected to the hybrid prosthesis (Figure 1 C, D, E).
After achieving haemostasis, the sternal head of the
sternocleidomastoid muscle is reattached using absorbable sutures and
chest closed in the usual manner.
When required, the following additional manoeuvres can be used to
increase the exposure of LSA. (i) Looping, Ligation and division of the
innominate vein (Figure 1A) (ii) When the LCCA is used for arterial
inflow, both the incisions can be connected (Figure 1B) and (iii) during
the antegrade cerebral perfusion, the cross-clamp on the LCCA can be
applied in the neck to avoid any paraphernalia in the operative field
(Video 1).