Related Experiment Video
Updated: Jun 27, 2026
Novel and Innovative Hybrid Technique for Type A Aortic Dissection
Published on: March 28, 2025
One-stage repair of extensive chronic aortic dissection using the arch-first technique and bilateral anterior
Nicholas T Kouchoukos1, Paolo Masetti, Michael C Mauney
1Division of Cardiovascular and Thoracic Surgery, Missouri Baptist Medical Center, St. Louis, Missouri 63131, USA. ntkouch@aol.com
Insights
This study shows a safe one-stage surgical technique for extensive thoracic aortic replacement in chronic aortic dissection patients. The procedure offers a viable alternative with low mortality and reoperation rates.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Aortic Disease Management
Background:
- Chronic aortic dissection poses significant surgical challenges.
- Extensive thoracic aorta replacement requires careful procedural planning.
Purpose of the Study:
- To evaluate a one-stage surgical technique for extensive thoracic aorta replacement in chronic aortic dissection.
- To assess the safety and efficacy of this approach.
Main Methods:
- A cohort of 51 patients with chronic expanding thoracic aortic dissections underwent a single-stage procedure.
- The technique involved bilateral anterior thoracotomy, hypothermic circulatory arrest, and selective arch vessel reperfusion.
- Ascending aorta, entire arch, and varying lengths of the descending aorta were replaced.
Main Results:
- Hospital mortality was 3.9%, with 10% requiring reoperation for bleeding.
- No strokes occurred; one patient developed paraplegia.
- Five- and 7-year survival rates were 79% and 68%, respectively.
- Freedom from reoperation on the thoracic or abdominal aorta was 92% at 5 and 7 years.
Conclusions:
- The one-stage technique is a safe and suitable alternative for chronic thoracic aortic dissection with aneurysm.
- It mitigates risks associated with interval rupture and staged procedures.
- The approach demonstrates a low rate of reoperation on the remaining aorta.
Background:
We evaluated a one-stage technique for extensive replacement of the thoracic aorta in patients with chronic aortic dissection.
Methods:
Fifty-one patients with chronic expanding thoracic aortic dissections (48 type A, 3 type B with proximal extension) were treated with a single procedure using a bilateral anterior thoracotomy, hypothermic circulatory arrest, and reperfusion of the arch vessels first to minimize brain ischemia. Forty-six patients had previous operations: for acute type A aortic dissection (n = 36), aortic valve disease (n = 6), or coronary artery disease (n = 4). The ascending aorta and entire arch were replaced in all patients combined with varying lengths of the descending aorta.
Results:
Hospital mortality was 3.9% (2 patients). Five patients (10%) required reoperation for bleeding. Two patients were discharged on ventilatory support and 2 on dialysis. No patient sustained a stroke, and paraplegia developed in one. The 5- and 7-year survival rates were 79% and 68%. Freedom from reoperation on the thoracic or abdominal aorta was 92% at 5 and 7 years postoperatively. Serial tomograms have documented substantial enlargement of the residual dissected aorta in only 2 patients (reoperated).
Conclusions:
The technique is a safe and suitable alternative to the two-stage (elephant trunk technique) and hybrid procedures for treatment of chronic dissection with aneurysm of the thoracic aorta. It eliminates the risk of rupture in the interval between staged procedures and the risks associated with a second thoracic aortic procedure, and is associated with a low rate of reoperation on the remaining aorta.
