Sun's procedure for chronic type A aortic dissection: total arch replacement using a tetrafurcate graft with stented elephant trunk implantation.

The Sun’s procedure is a surgical technique that integrates total arch replacement using a tetrafurcated graft with implantation of a special stented graft in the descending aorta, as a treatment option for extensive dissections or aneurysms involving the ascending aorta, aortic arch and descending aorta (1-3). To illustrate our technique for performing the Sun’s procedure (1,2), we present a video of this approach in a 38-year-old man with chronic type A aortic dissection (Video 1). Video 1 Sun's procedure for chronic type A aortic dissection: total arch replacement using a tetrafurcate graft with stented elephant trunk implantation Clinical vignette The patient had a history of hypertension for twenty years and experienced an episode of chest and flank pain after exertion one year ago. Transthoracic echocardiogram detected dilated ascending aorta, aortic arch and descending aorta, as well as intimal flaps in the ascending aorta, and a dilated aortic root with severe regurgitation. Computed tomographic angiogram confirmed a chronic type A dissection, with the intimal tear in the ascending aorta, extending distally to the right iliac artery, and the arch vessels involved. Of note, the innominate artery was both aneurysmal and dissected for the entire length extending to the level of bifurcation. There was also a coronary anomaly, in which the left and right coronary arteries arose from the left coronary sinus. Considering the complex pathology of arch vessel involvement, innominate artery aneurysm, aortic root dilation with severe regurgitation and coronary artery anomaly, we decided to perform the Sun’s procedure, in combination with composite root replacement with a mechanical valved conduit.