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Published on: March 28, 2025
Extended replacement of the thoracic aorta
Yutaka Hino1, Kenji Okada, Takanori Oka
1Department of Surgery, Division of Cardiovascular Surgery, Kobe University Graduate School of Medicine, Kobe, Japan.
Summary
This study on total aortic arch replacement for extensive thoracic aneurysms shows satisfactory outcomes. Specific strategies and organ protection led to good results in selected patients.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Vascular Surgery
Background:
- Extended thoracic aortic aneurysms pose significant surgical challenges.
- Aneurysm pathology includes non-dissecting aneurysms and various types of aortic dissection.
- Previous interventions varied, including Bentall procedures, endovascular stenting, and hemi-arch replacement.
Purpose of the Study:
- To present the surgical experience with total aortic arch replacement for extended thoracic aortic aneurysms.
- To evaluate the outcomes and safety of this complex procedure.
- To highlight the importance of tailored strategies for aneurysm extension and organ protection.
Main Methods:
- Twenty-nine patients underwent graft replacement for extended thoracic aortic aneurysms.
- Surgical approaches included posterolateral thoracotomy, extended thoracotomy, and sternotomy variations.
- Aortic replacement extended from the aortic root or ascending aorta to the descending or abdominal aorta.
Main Results:
- Operative, 30-day, and hospital mortality rates were low (one each).
- Late mortality occurred in three patients due to unrelated complications.
- Five-year actuarial survival was 80.6%, with 96.0% freedom from subsequent aortic events.
Conclusions:
- Total aortic arch replacement can achieve satisfactory results for extensive thoracic aneurysms.
- Specific surgical strategies and organ protection are crucial for successful outcomes.
- This approach is effective in selected patients requiring complex aortic reconstruction.
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