Combining our extensive portfolio of Gelweave™ debranching grafts with Thoraflex™ Hybrid facilitates the 'Branch First' technique for optimised intervention


Hybrid Branch First Approach

Despite significant advances in products and surgical technique, the incidence of cerebral injury in total arch replacement remains high.

To improve outcomes many centres have implemented a 'branch first' approach to facilitate continuous perfusion.

The 'branch first' procedure consists of sequential short period clamping and reperfusion of the three arch branches without circulatory arrest.

Arch replacement using the 'branch first technique' allows for complete root, ascending aorta, and arch replacement.

Trifurcate Arch Graft and Thoraflex™ Hybrid device

*Configuration illustrates the combination of Trifurcate Arch Graft with Side Branch and Thoraflex™ Hybrid device.

Trifurcate Arch Graft with Side Branch

Gelweave™ Trifurcate Arch Graft with Side Branch

This configuration enables the distal anastomosis to be performed with a cross clamp allowing distal organ perfusion to continue. The trifurcation is anastomosed to the main body graft sufficiently proximally to allow a long landing zone for subsequent endovascular stenting.

Key features

  • Avoids deep hypothermia 1
  • Little or no distal circulatory arrest 2
  • Reduced cardiac ischaemic time 2
  • No cerebral circulatory arrest 3
Trifurcate Arch Graft

Gelweave™ Trifurcate Arch Graft

The Gelweave™ Trifurcate Arch Graft permits expeditious arch reconstruction and neurologic sequelae 5, while providing the flexibility to adapt to arch anomalies.

Key features

  • Shortens hypothermic circulatory arrest times 4
  • Minimises cerebral ischaemia 5
  • Reduces the risk of embolisation 5
  • Minimises adverse outcomes 4
  • Complements first stage elephant trunk repair 4
Antegrade Hybrid Arch Graft with Radiopaque Marker

Gelweave™ Thoracic Arch Graft with Radiopaque Marker

This configuration enables the innominate and left common carotid arteries to be relocated onto the proximal ascending aorta to create a proximal landing zone for planned endovascular repair of the aortic arch.

Key features

  • Hybrid aortic debranching technique with this graft and an endovascular graft may be ideally suited to patients with significant comorbidities 6
  • Allows for antegrade or retrograde deployment of TEVAR 7
Trifurcate graft with side branch and Radiopaque marker

Gelweave™ Trifurcate Graft with side branch and Radiopaque marker

Branched graft for repair of diseased and damaged thoracic and abdominal aorta, and associated side vessels. 8

Key features

  • Cannulation and perfusion via the graft’s side branch allowed complete antegrade cerebral perfusion 9

Antegrade flow made easy by the perfusion side branch may offer:

  • lower risk of neurological deficits 10
  • preventive effect against embolic stroke 10
Gelweave™ Lupiae

Gelweave™ Lupiae

The unique debranching elements of the Gelweave™ Lupiae facilitates the rerouting of neck vessels on the proximal ascending aorta and the creation of a long, stable and durable landing zone for further endovascular interventions. 11, 12

Key features

  • Enables individual arch vessel reconstruction 12
  • Radiopaque markers facilitate second stage endovascular repair 12

Product Disclaimer

Hybrid and debranching indication subject to local regulatory approval.
Product availability subject to regulatory approval.



    Matalanis G, Shi WY. An Australian Experience with Aortic Arch Replacement: A Novel Approach without Circulatory Arrest or Deep Hypothermia. Heart Lung Circulation, 2010, 20, 163-169.

    Matalanis G et al. Branch-first Aortic Arch Replacement with no Circulatory Arrest or Deep Hypothermia. J Thoracic Cardiovasc Surgery, 2011, 142, 809-815.

    Galvin SD, Matalanis G. Continuous perfusion Branch First aortic arch replacement: a technical perspective. Ann Cardiothorac Surg, 2013, 2(2), 229-234.

    Strauch JT. et al. Technical Advances in Total Aortic Arch Replacement. Ann Thorac Surg. 2004; 77: 581-590.

    Spielvogel D. et al. Aortic Arch Reconstruction Using a Trifurcated Graft. Ann Thorac Surg. 2003; 75: 1034-1036.

    Hughes, G Chad, et al. Use of custom Dacron branch grafts for “hybrid" aortic debranching during endovascular repair of thoracic and thoracoabdominal aortic aneurysms. The Journal of thoracic and Cardiovascular Surgery, 2008, Vol. 136, pp. 21-8.

    Andersen, Nicholas D, et al. Results with an algorithmic approach to hybrid repair of the aortic arch. National Harbor: s.n., June 7-9, 2013, Society for Vascular Surgery.

    Esposito G, et al. (2008). Hybrid Treatment of Thoracoabdominal Aortic Aneurysms with the Use of a New Prosthesis. Ann Thorac Surg, 85: 1443- 1445.

    Masiello P MD, et al. (1997). The Use of Profound Hypothermia and Circulatory Arrest in Operations on the Thoracic Aorta. Eur J Cardio-Thoracic Surg, 11: 176-181.

    Ehrlich M, et al. (1994). Operative Management of Aortic Aneurysms Using Profound Hypothermia & Circulatory Arrest. International Congress on Thoracic Aortic Aneurysms, Austria, 12-14th June 1994.

    Esposito G et al. Mid-term Results of the Lupiae Technique in Patients with De Bakey Type I Acute Aortic Dissection. Eur J Cardio-Thoracic Surgery. 2012;1-7.

    Esposito G et al. Hybrid Repair of Type A Acute Aortic Dissections with the Lupiae Technique: Ten-year results. J Thoracic and Cardiovasc Surg. 2015;Vol 149, S99-S104.