veerbiage:

Once an adequate arrest had been obtained. the aorta was then opened transversely and was found to be dissected down just above the sinotubular junction with an obvious tear in the ascending. During this time systemic cooling was initiated. Attention was first turned to the root end of the aorta. The aorta was trimmed back to just above the sinotublular junction. the valve was resuspended with pledgeted Prolene sutures just above each commissure. The aortic layers were then reconstituted with felt outside with 3-0 Prolene in a running fashion. Around this time the physician reported that the temperature of 70 degrees Celsius had been obtained. At this point circulatory support was ceased and the aortic clamp was released. The aorta was resected back to just under the innominate. When the interior of the arch was inspected we encountered what appeared to be the start of the dissection. It was a tear between the left carotid and the left subclavian artery extending ip toward teh cranial surface of the arch. The was reapproximated with several felt pledgets including a felt strip on the outside and on the inside.

The posterior surface of the aortic arch appeared normal. At this point, the ylayers were reapproximated using a felt strip outside and running 3-0 Prolene. The aorta had been measure at the sinotubular juction and the arch. A 30mm graft was then obtained ad then anastomosed using 3-0 Prolene. As soon as the anastomosis was complete, the graft was coated with bioglue exteriorly. circulatory support was slowly support was slowly reinstituted. Attention was turned to the root end of the anastomosis. the graft was then cut to fit and anastomosed using 3-0 Prolene in a running fashion.. the initial rhythm was fibrillation which converted to sinus rhythm with single cardioversion.