In patients without aortic arch calcification, elective total ascending aorta replacement can be performed without circulatory arrest, by positioning obliquely a clamp from the brachiocephalic trunk, which is partially clamped, to the distal aortic arch.

In order to offer selected patients undergoing composite aortic root replacement the advantages of a tissue valve, we have constructed conduits intraoperatively by suturing a stented bovine pericardial valve (Edwards Lifesciences LLC, Irvine, CA) inside of a Dacron tube graft (Boston Scientific Corp, Natick, MA). The conduit is quickly made from readily available materials, is easily implanted, and can accommodate any of the anatomic situations encountered in repair of aortic root aneurysms. It is particularly suitable for patients 65 years of age and older.