Aortoplasty for management of the dilated distal ascending aorta during proximal aortic reconstruction.

When aneurysms of the ascending aorta extend into the arch, the conventional approach is replacement with a Dacron graft, including a distal beveled hemiarch anastomosis with the patient under hypothermic circulatory arrest. For certain cases, we propose an alternative strategy combining replacement of the proximal and middle segments of the ascending aorta with external wrapping aortoplasty for the distal segment. This "turtleneck" aortoplasty achieves successful complete repair of the ascending aorta without the risks associated with circulatory arrest.