Practical Tips in Aortic Surgery

Dr. John Elefteriades is the William W.L. Glenn Professor of Cardiothoracic Surgery. He served as Chief of Cardiothoracic Surgery at Yale University and Yale New-Haven Hospital until he became the Founding Director of the Aortic Institute at Yale in 2011. He received all his training, including undergraduate education, medical school, and residency at Yale, where he then joined  the faculty of the Yale University School of Medicine.  Dr. Elefteriades served on the Board of Governors of the American College of Cardiology.  Dr. Elefteriades served as President of the International College of Angiology. He is Editor-in-Chief of the journal AORTA, which he founded. He has been named consistently among The Best Doctors in America.  He is a frequently requested international lecturer, visiting professor, and guest surgeon—having lectured and/or operated in 33 countries. He is the author of over 450 scientific publications. He wasselected as one of the ten best doctors in America by Men’s Health magazine. He has been featured in many dozens of print, radio, and television presentations. He has received the Walter Bleifeld Memorial Award for Distinguished Contribution in Clinical Research in Cardiology and the John B. Chang Research Achievement Award. In 2006, he received the Socrates Award from the Society of Thoracic Surgeons, recognizing exceptional achievement in teaching and mentorship of residents. Dr. Elefteriades was named the William W.L. Glenn Professor of Cardiothoracic Surgery in 2006. In addition to many medical textbooks,  Dr. Elefteriades published the book Extraordinary Hearts, telling ten inspirational and instructional patient stories for the general public, as well as his first fiction work, the award winning medical mystery/ethics thriller Transplant. In 2018, Dr. Elefteriades was awarded an Honorary PhD by the University of Liege, in recognition of contributions tothe science and treatment of aortic disease. In 2019, Dr. Elefteriades was inducted into the highly select Athens Academy, the highest academic honor bestowed by Greece for accomplishment in any scholarly discipline. In 2020, Dr.Elefteriades was designated by  expertscape as the “top-rated expert in Aortic Aneurysm in the world.” National Public Radio (NPR) recently referred to Dr. Elefteriades as “one of the best doctors in the country, and an “icon” of cardiac surgery”.Dr. Bulat A. Ziganshin is an Associate Research Scientist of Surgery (Cardiac Surgery) at Yale University School of Medicine. He is the Research Director at the Aortic Institute at Yale-New Haven Hospital. Dr. Ziganshin received his Medical Doctor (MD) Degree and a PhD Degree in Pharmacology from Kazan State Medical University (Kazan, Russia) where he also completed residency training in Cardiovascular Surgery. After completion of training, Dr. Ziganshin joined thefaculty at Yale University in a clinical research capacity. Dr. Ziganshin’s primary research interests include aortic disease, genetics and genomics, cardiac surgery, pharmacology, and global health. He has published over 160 scientific manuscripts in peer-reviewed journals, as well as 17 chapters in textbooks, and co-authored five drug reference books. Since 2012, Dr. Ziganshin serves as an Associate Editor of AORTA Journal.

• Section 1. General Tips.- General Approach.- Cannulation Sites.- Bevel Your Distal Ascending or Hemi-Arch Anastomosis.- Aortic Wrap.- Carbon Dioxide Flooding of the Pericardial Well.- Innominate Vein Ligation.- Pericardial Bridge for Delayed Sternal Closure.- Pull Hard on Graft to Measure Length.- Reduction of Graft Diameter.- Increase of Graft Diameter.- Reinforcement of Posterior Wall of Aortic Anastomosis.- “Retrosternal Sponge” Re-entry Technique.- Reinforced Sternal Closure.- The Tightening Stitch.- Towel Clip Technique to Control Re-entry Bleeding.- Turn Off LV Vent Well Before Finishing Last Ascending Suture Line.- Conduct of DHCA.- Clamping the Aorta.- Other Cerebral Perfusion Strategies.- Swing Venous Line Down to Expose Aortic Root.- Intraoperative Malperfusion.- Surrounding the Ascending Aorta—Without Injuring the PA.- Do NOT obliterate a chronic flap.- Hugging but not Restricting the Innominate Artery with the Clamp.- Do Not Cut Too Close to the Clamp.- Graft Sizing.- “Valerie Stitch” for Exposure of the Aortic Root.- Cannulation of Left Inferior Pulmonary Vein.- Left Atrial Cannulation in Atrial Fibrillation.- The E-Rule: Never Start LA-FA Artery Perfusion w/o the Aorta Clamped.- Remember the Pulmonary Artery for “Venous” Return.- Mobilize the Posterior Wall Completely.- Mobilize the Descending Aorta from the Esophagus.- Sub-adventitial Hematoma.- Sienna graft for Mega-aorta.- The “Inclusion” Anastomotic Technique.- Big Needle for Thick Aortas.- Aneurysms of the Branches of the Aortic Arch.- Attaching Arch Graft to Ascending Graft (Configurations).- BioGlue on Graft-to-Graft Anastomoses.- Lung Adhesions.- Adherence of Aneurysm to Chest Wall.- Reoperative Adhesions.- Extracting old prosthetic valves.- Section 2. Ascending Aortaand Aortic Arch.- Aortic Morphology Determines Extent of Resection.- Use the Corner of the Commissure to Advantage.- Aortic Valve Repair.- Ascending Aortic Replacement (*deeper stitches on non-coronary sinus).- Composite Graft (Aortic Root Replacement) (Bentall Procedure).- Composite Graft (Aortic Root Replacement) (Bentall Procedure).- V-Shaped Aortic Root Remodeling.- Valve-Sparing Aortic Root Replacement.- Arch Replacement Options (2-vessel, 3-vessel, trifurcated graft).- Standard (Non-Frozen) Elephant Trunk Procedure.- Retrieving the Elephant Trunk—Four Options.- Stand-alone Elephant Trunk.- Acute Type A Aortic Dissection.- Ross Procedure.- Section 3. Descending and Thoracoabdominal Aorta.- Descending Aortic Replacement.- Acute Type B Aortic Dissection: Clinical Perspectives to Guide Surgery.- Fenestration Procedure.- Thoracoabdominal Aortic Replacement.- Abdominal aorticreplacement.- Visceral artery aneurysms.- Pulmonary Artery Aneurysms.- Section 4. Vascular Rings.- General Comments.- Vascular Rings and Kommeril’s Diverticula.