C-TAR procedure

The c-TAR refers to Sun’s procedure, which has been reported previously (6). Briefly, the three supra-aortic branches were extensively dissociated and the distal aorta was transected just proximal to the origin of the LSA. The stent graft, which was similar to that used in the s-TAR, was implanted in the descending aorta. The proximal end of the stented graft was positioned just distal to the origin of the LSA. The distal aorta containing the intraluminal stented graft was firmly anastomosed with the 4-branched arch graft, followed by resumption of lower-body perfusion through the perfusion limb of the 4-branched arch graft. Finally, the LSA, left common carotid artery, and innominate artery were anastomosed to the respective limbs of the 4-branched arch graft.

After rewarming, SCP was discontinued, and the systemic circulation was gradually restarted. The remainder of each procedure, including hemostasis and sternal closure, were performed routinely.