In some minimally invasive cases where the ascending aorta is replaced at the level of the STJ and the AV is sparred (not a David procedure, a supra-coronary replacement), I find it valuable to use 2 separate grafts. One segment of graft is initially anastomosed to the hemi -arch or the distal ascending aorta and the other segment of graft to the STJ. These are then beveled and sewn together. This 2 graft technique is especially helpful if the proximal anastomosis ( STJ) is far away.
The technique that I have used to suture this proximal anastomosis entails inverting the proximal graft into the root and suturing it with a running suture. Once complete the small segment of graft is pulled from the root and there is a very hemostatic closure. The pictures below demonstrate the technique.
Posted in Aortic Valve Surgery, Ascending Aorta
The eversion technique has been described long time ago and as you mentioned it is very hemostatic and straight forward technique. I would like to have some information and photos on how you perform the distal anastomosis on the aortic arch.
Thank you a lot and again congratulations for your achievements
A.P.
I submitted an article to Innovations on How to Do. Hopefully will be out soon. If you are at the STS meeting in Arizona, I will be presenting a video on the mini acscending aortic surgery.