[[100 Welcome to Outlines of Technique in Cardiac Surgery]] # Technical Outline of Repair of Aortic Dissection ## Cannulation, Sternotomy, Cardiopulmonary Bypass, Cooling to Hypothermia - Arterial access [^a] - Axillary Artery Cannulation - Alternatives - Femoral - Carotid - Direct - [[Sternotomy]] - Heparin - [[Venous Cannulation]] - [[Cooling for Hypothermic Circulatory Arrest]] - [[LV Vent Cannulation Stitch]] and [[LV Vent Insertion]] - [[Retrograde Pursetring and Insertion of Retrograde Cannula]] - [[Carbon Dioxide]] - [[Do I cross clamp?]] - [[Separation of Aorta and Pulmonary Artery]] ## Cardiac Arrest and Preparation of the Aortic Root - [[Cross Clamp (Aortic Dissection)]] - [[Transect the aorta]] - [[Cardioplegia During Repair of Aortic Dissection]] - [[Staring into the root- Preservation or Replacement]] - Preservation - [[Resection of Unnecesary Aortic Root Tissue]] - [[Closing false lumen in the root with BioGlue]] - [[Resuspension with the Sandwich]] ## Circulatory Arrest, Preparation of the Arch, Distal Anastomosis - Circulatory arrest - [[Staring into the arch- Preservation or Replacement]] - [[Cerebral perfusion]] - [[Resection of Unnecessary Ascending Aortic Tissue]] - [[Hemi-arch Sandwich]] - Graft sizing - Distal anastomosis - Cross clamp on graft - Circulatory arrest ends ## Warming and the Proximal Anastomosis - Warming - Inspecting the suture line - Assessment of the length of the graft - Anastomosis to the Sinotubular Junction - Release of cross clamp ## Reperfusion of the Heart, Rhythm Restoration, Warming to Normothermia and Hemostasis - Suture line inspection - Packing the suture lines and the vulcan nerve pinch - Assessment of residual regurgitation - Rhythm and warming - Protamine reversal - Packing with "Spray-tech"s - Final inspection ## Decannulation - Decannulation - Replacing the "Spray-tech"s with surgicel - Arterial decannulation ## Sternotomy and Incision Closure - Sternotomy closure - Axillary artery incision closure - Pulse check [^a]: [[The Evolution of My Cannulation Strategy for Aortic Dissection]]