Pull-through technique for entire thoracic aortic dissection without additional left thoracotomy

Urgent single-staged replacement of the aortic dissection involving the entire thoracic aorta was performed by using the modified pullthrough technique via median sternotomy. Distal anastomosis was achieved via posterior pericardium to avoid the lateral thoracotomy and then the graft was pulled through the false lumen of the descending aorta into the aortic arch. Each lumen between proximal and distal anastomosis was closed for hemostasis. The aortic arch was replaced with a four-branched graft. Postoperative course was uneventful. This procedure might be an alternative in selected patients to the left thoracotomy.