. left carotid bypass at the neck with 6-8 mm graft, then CPB through femoral artery and right subclavian artery, 2. Stop femoral circulation, keep cerebral perfusion only, 3. small incision on the ascending aorta for examination and searching the intimal tear, 4. If no tear was found in the ascending aorta, then extend the incision to aortic arch and insert a ringed graft into the aortic root, then fix the VRC with tapes, then give cardioplegia (preferably HTK for it may last longer), 5. search the intimal tear again, if it is not in the arch, then use 10-15 cm elephant trunk to repair the upper portion of descending aorta. The ring shoud be placed at the distal arch, 6. innominate artery bypass with a 10-12 mm ringed graft though the aortotomy, then anastomose it to the aorta. The graft should be very short, usually 1-2 cm long, 7. anastomose the left carotid bypass graft to the aorta, 8. use a ring (telescope type) or suture technique to anastomose the arch graft and the aortic root graft.
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