“Peninsula-Style” Transverse Aortic Arch Replacement in Patients With Bicuspid Aortic Valve Akinobu Itoh, MD, Michael Fischbein, MD, PhD, Koji Arata,

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“Peninsula-Style” Transverse Aortic Arch Replacement in Patients With Bicuspid Aortic Valve Akinobu Itoh, MD, Michael Fischbein, MD, PhD, Koji Arata, CCP, David Craig Miller, MD The Annals of Thoracic Surgery Volume 90, Issue 4, Pages 1369-1371 (October 2010) DOI: 10.1016/j.athoracsur.2009.11.029 Copyright © 2010 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 Three-dimensional reconstruction of computed tomographic angiogram in a representative patient with (A) Fazel-Stanford cluster III aneurysmal changes in the ascending aorta and arch, but normal sinuses of Valsalva, and (B) Fazel-Stanford cluster IV aneurysmal dilatation involving the aortic root, ascending aorta, and transverse arch. Note that the descending aorta is normal size in both cases. The Annals of Thoracic Surgery 2010 90, 1369-1371DOI: (10.1016/j.athoracsur.2009.11.029) Copyright © 2010 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 “Peninsula-style” transverse arch replacement concomitant with Tirone David-V valve-sparing aortic root replacement Stanford modification. (A) Dilated ascending aorta and transverse arch in a patient with bicuspid aortic valve (BAV) and bovine aortic arch. A 6-mm graft (Maquet, Wayne, NJ) is sutured on the innominate artery for systemic cardiopulmonary bypass perfusion and selective antegrade cerebral perfusion. (B) The transverse aortic arch is resected leaving only a small rim of aorta on the greater curve surrounding the arch branches. (C) The first line suture for the valve-sparing. Note that the BAV illustrated is the most common type (Sievers type 1/L-R) of BAV [7]. (D) The second line suture for the valve-sparing. (E) After peninsula-style arch replacement. Most of the transverse aortic arch, as well as all of the aortic root and ascending aorta are replaced with the Dacron graft (Maquet). The Annals of Thoracic Surgery 2010 90, 1369-1371DOI: (10.1016/j.athoracsur.2009.11.029) Copyright © 2010 The Society of Thoracic Surgeons Terms and Conditions