Figure 3.

(A) When a FET is used, the “branch first” arch reconstruction proceeds as described above. Under moderate hypothermic arrest, the FET is positioned and deployed in the true lumen in the descending thoracic aorta. The distal anastomosis is again constructed, usually in Zone 2, and antegrade systemic perfusion recommenced; (B) after completion of the root reconstruction, the TAPP graft is then connected proximally. Depending on the lie of the TAPP graft, it may either be connected to the first limb of the FET graft or the anastomosis can be constructed in a similar fashion to Figure 2. FET, frozen elephant trunk.