Total arch set-up

Schematic of the cardiopulmonary bypass set-up used for total arch replacement. Optimal exposure is achieved by keeping cannulas low profile and tucked out of the operative field. Central arterial cannulation with bi-caval venous cannulation is preferred. An LV vent is placed in the superior pulmonary vein, antegrade cardioplegia is given via the aorta, and retrograde cardioplegia is given via the coronary sinus.