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Updated: Jul 17, 2026
Novel and Innovative Hybrid Technique for Type A Aortic Dissection
Published on: March 28, 2025
Optimization of aortic arch replacement with a one-stage approach
Nicholas T Kouchoukos1, Michael C Mauney, Paolo Masetti
1Division of Cardiovascular and Thoracic Surgery, Missouri Baptist Medical Center, St. Louis, Missouri, USA. ntkouch@aol.com
Insights
A one-stage surgical repair for extensive thoracic aortic disease is a safe alternative to staged procedures, reducing mortality and improving patient survival.
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.
Background:
Staged procedures for extensive aneurysmal disease of the thoracic aorta are associated with a substantial cumulative mortality for the two procedures and death in the interval between, often from aortic rupture. We have used a one-stage approach for operative repair of most, or all, of the thoracic aorta.
Methods:
Sixty-nine patients were treated using a bilateral anterior thoracotomy with transverse sternotomy, hypothermic circulatory arrest, and reperfusion of the arch vessels first to minimize brain ischemia. Forty-two patients had chronic ascending aortic dissections (all but 1 had a previous operation), 24 had degenerative aneurysms, and 3 had chronic descending aortic dissections with proximal extension. The ascending aorta and aortic arch were replaced in all patients combined with resection of various lengths of descending aorta.
Results:
In-hospital mortality was 7.2% (5 patients). Morbidity included reoperation for bleeding (13%), mechanical ventilation for more than 72 hours (50%), temporary tracheostomy (13%), and temporary renal dialysis (9%). No patient sustained a stroke. There have been 9 late deaths unrelated to the aortic disease. Four patients have undergone successful reoperation on the aorta for false aneurysm in 1, endocarditis in 1, and progression of disease in 2. Survival at 5 years was 71%.
Conclusions:
The one-stage arch-first technique is a safe and suitable alternative to the two-stage procedure for repair of extensive thoracic aortic disease.