Aiming at one-stage corrective surgery for extended thoracic aortic dilatation

Area of Science:

• Cardiovascular Surgery
• Vascular Pathology
• Immunohistochemistry

Background:

• Extended thoracic aortic dilatation presents significant surgical challenges.
• Histopathological examination of resected aortic tissue may uncover undiagnosed aortitis, influencing surgical outcomes.

Purpose of the Study:

• To evaluate the benefits of comprehensive histopathology following one-stage corrective surgery for extended thoracic aortic dilatation.
• To assess the impact of inflammation, specifically immunoglobulin G4 (IgG4)-positive aortitis, on postoperative outcomes.

Main Methods:

• Five patients with extended thoracic aortic dilatation underwent one-stage hybrid open arch repair with frozen elephant trunk and endovascular aortic grafting.
• Resected aortic arch samples were analyzed using immunohistochemistry to detect T- and B-lymphocytes, plasma cells, macrophages, and IgG4 positivity.

Main Results:

• The hybrid approach achieved complete false lumen thrombosis in dissection patients and successful exclusion of atherosclerotic dilatation in one patient.
• One patient with atherosclerotic dilatation was diagnosed with IgG4-positive aortitis and experienced postoperative blindness, despite no embolic events.
• Mean follow-up was 18 months, demonstrating the feasibility of the hybrid repair for definitive treatment.

Conclusions:

• Hybrid open arch repair with frozen elephant trunk and endovascular grafting is a viable one-stage surgical option for extensive thoracic aortic pathology.
• Systematic histopathological evaluation is crucial for identifying concealed aortitis, which can affect postoperative outcomes and necessitate long-term patient surveillance.