Optimization of aortic arch replacement with a one-stage approach.

Area of Science:

• Cardiovascular Surgery
• Thoracic Surgery
• Aortic Aneurysm Repair

Background:

• Staged procedures for extensive thoracic aortic disease carry high cumulative mortality and risk of death between operations.
• Aortic rupture is a significant concern in the interval between staged repairs.
• A one-stage approach aims to mitigate these risks by addressing most or all of the thoracic aorta in a single operation.

Purpose of the Study:

• To evaluate the safety and efficacy of a one-stage surgical approach for extensive thoracic aortic disease.
• To compare the outcomes of the one-stage technique with traditional two-stage procedures.

Main Methods:

• Sixty-nine patients underwent a one-stage repair using bilateral anterior thoracotomy, transverse sternotomy, and hypothermic circulatory arrest.
• Reperfusion of the arch vessels was performed first to minimize cerebral ischemia.
• Procedures involved replacement of the ascending aorta and aortic arch, with resection of varying lengths of the descending aorta.

Main Results:

• In-hospital mortality was 7.2% (5 patients).
• Major morbidities included reoperation for bleeding (13%), prolonged ventilation (50%), and temporary renal dialysis (9%).
• Five-year survival was 71%, with no strokes reported.

Conclusions:

• The one-stage arch-first technique is a safe and suitable alternative for extensive thoracic aortic disease.
• This approach effectively reduces the risks associated with staged repairs.