Aorto-Innominate Artery Bypass – Aortic Debranching

Aorto-Innominate Artery Bypass

The Set Up

  1. Room/back table set up and patient position – it is most similar to CABG
  2. Pump standby, run ACT
  3. Cell Saver
  4. 8mm and 10mm Gore-tex graft, gore tex suture with sizes 4,5,6 and various needle sizes/types
  5. Left radial a-line
  6. Central line – no swan
  7. Prep to knees

Procedure

Median Sternotomy, vanco paste, gel foam, sleeves, retractor, open pericardium, pericardial sutures, heparinize, check ACT

Dissection

I do most of the dissection before heparin, dissect out the ascending aorta if there are adhesions, innominate vein (umbilical tape), innominate artery (umbilical tape), subclavian artery (blue vessel loop) and carotid artery (blue vessel loop).

Create aortic anastomosis first,  performed off pump, approx 5,000 units of heparin bolus, place sidebiting clamp on ascending aorta, create aortotomy (remove some aortic wall to make an oval, since graft is large).

Completed Anastomoses (Aorto-Innominate Artery Bypass)

Note: The origin of graft arises from the aorta slightly rightward of midline.  I find the course of the graft is better with this take off point, in this procedure, and in debranching for arch aneurysms. Finally, we found better results with the graft coursing anterior to the innominate vein.