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Optimization of aortic arch replacement: two-stage approach.

Hazim J Safi1, Charles C Miller, Anthony L Estrera

  • 1Department of Cardiothoracic and Vascular Surgery, The University of Texas at Houston Medical School, Memorial Hermann Heart and Vascular Institute, Houston, Texas 77030, USA. hazim.j.safi@uth.tmc.edu

The Annals of Thoracic Surgery
|January 30, 2007
PubMed
Summary

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The Fate of Aortic Arch After Open Descending Thoracic and Thoracoabdominal Aortic Aneurysm Repair.

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Extensive aortic aneurysms involving the aortic arch, ascending, and descending aorta can be effectively treated with a two-stage surgical approach. This staged repair offers acceptable outcomes, with kidney function (glomerular filtration rate) impacting first-stage results.

Area of Science:

  • Cardiovascular Surgery
  • Vascular Surgery
  • Aortic Aneurysm Repair

Background:

  • Aortic arch aneurysms often extend to involve the ascending and descending thoracic or thoracoabdominal aorta.
  • These extensive aortic aneurysms typically require a multi-stage repair strategy.
  • A staged approach allows for sequential repair, prioritizing the ascending aorta and arch first.

Purpose of the Study:

  • To evaluate the efficacy and safety of a two-stage surgical approach for extensive aortic aneurysms.
  • To assess the outcomes, including mortality and morbidity, of staged aortic aneurysm repair.
  • To determine factors influencing surgical outcomes in patients undergoing staged aortic repair.

Main Methods:

  • A retrospective review of 2120 patients undergoing aortic aneurysm repair between 1991 and 2005.

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  • Identification of 254 patients (12.0%) with extensive aortic aneurysms involving the ascending, arch, and descending aorta.
  • Analysis of outcomes for 254 first-stage repairs and 115 second-stage repairs.

    • Main Results:

    • First-stage 30-day mortality was 6.3%, with significantly higher mortality in patients with glomerular filtration rate (GFR) < 70 mL/min (10.5% vs 2.9%).
    • Second-stage 30-day mortality was 9.6%, with no significant difference based on GFR.
    • Postoperative stroke incidence was 2.0% in the first stage, and neurologic deficit (paraplegia/paraparesis) was 0.9% in the second stage.

    Conclusions:

    • A two-stage repair technique is effective for extensive aortic aneurysms involving the transverse arch, ascending, and descending aorta, with acceptable morbidity and mortality.
    • Glomerular filtration rate is a significant predictor of surgical outcomes in the first-stage repair.
    • Prompt treatment of the remaining aortic segments after the initial stage is critical for successful overall management.