How to parachute. It’s really an important technique to learn. The most important things to have. Long suture. 48 inch 4-0 BB for proximal anastomosis. I put 4-5 stitches in, then bring down graft. Especially useful in deep holes. 1st year fellow doing end to end to beveled aorta

Keep the graft up in the air, and keep the sutures under tension. The assistant pulls the sutures and graft in the opposite direction from the surgeons direction of suturing. Hemostat on graft prevents it from being pulled down. Practice, you’ll love it.

Start on the back wall away from you. This allows you to sew the entire back wall toward you under direct visualization. I do like to fully transect the entire aorta, but it’s not necessary to do

And lastly an assistant that understands the concept. In this case I’m the assistant. But I’m some cases I have the fellow be assistant because they are equally important

Professor what is the extension of the posterior wall that you suture until down the parachute suture and complete the posterior wall? The 30%, 50% or 70%? #AortaEd

I try to complete the entire back wall for the most part, let’s say 75%. Sometimes depends on the overall depth of the patient and there size

What great mentorship to pass on this magnificent art of life saving work to the next generation! Kudos to the mentor and how fortunate is the apprentice 👏👏👏

This is cool. Do you do inside-out in aorta even if you don't transect?

You can either way, for him was easier inside out on aorta. But when we end with that suture, when you grab the other end then everything thing else is opposite. So the initial shodded suture would outside in on the aorta and inside out on graft.

When do you put in the radiopaque pledgets?

There's an artistry to this work.

Surgery is an art