Figure 2.

Operative procedure for the SIS graft prosthesis and video screenshots of the operation. (A) The aortic arch is dissected transversely, four sutures are applied evenly around the aortic wall, and a retrogradely inserted guidewire is threaded through an eyelet on the distal end of the delivery system. (B) The sutureless region and stented-graft region are deployed into the descending aorta over the guidewire and released by drawing out the pull ring on the proximal end of the delivery system. (C) The guidewire and delivery system are removed from the femoral access and the proximal orifice of the 4-branched vascular graft trunk, respectively. (D) The restraint sutures are securely tightened and tied in situ, and then tied with the corresponding silk sutures already threaded on the aortic wall. (E) The perfusion to the lower part of the body is restarted via the femoral cannula. On the area corresponding to the sutureless elastic support annulus, a sutureless belt is looped around the aortic adventitia and then fastened by truning the ratchet with the wrench. (F) The supra-aortic vessels and ascending aorta are anastomosed. (G) The appearance of the distal anastomosis site after fastening the sutureless belt. (H) The operative field is clear without bleeding from the distal anastomosis site when performing the David procedure.