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Single-stage total aortic replacement in patients with mega-aortic syndrome
Eduard Charchyan1, Denis Breshenkov2, Yuriy Belov1
1Unit of Aortic Surgery, Department Aortic Surgery, Petrovsky National Research Center of Surgery, Moscow, Russia.
The Journal of Cardiovascular Surgery
|May 20, 2021
Summary
Single-stage total aortic replacement (TAR) is a safe option for younger, fit mega-aortic syndrome (MAS) patients, offering acceptable mid-term outcomes. This approach may reduce surgical trauma compared to staged procedures.
Area of Science:
- Cardiovascular Surgery
- Vascular Surgery
- Thoracic Surgery
Background:
- Staged total aortic replacement (TAR) is standard for mega-aortic syndrome (MAS) with comorbidities.
- A single-stage TAR approach may benefit younger, healthier MAS patients.
- This study evaluates mid-term outcomes of single-stage TAR in MAS.
Purpose of the Study:
- To assess the safety and efficacy of single-stage total aortic replacement (TAR) in mega-aortic syndrome (MAS) patients.
- To analyze mortality, major adverse postoperative events, and long-term outcomes.
- To compare the single-stage approach with traditional staged procedures.
Main Methods:
- Retrospective review of MAS patients undergoing single-stage TAR (May 2016 - Dec 2020).
- Analysis of primary endpoints: mortality and major adverse postoperative events.
- Secondary endpoints included re-intervention, complications, and survival.
Main Results:
- 13 of 47 MAS patients (27.7%) underwent single-stage TAR.
- In-hospital mortality was 15.4% (stroke, prosthesis infection).
- Complications included stroke (15.4%), paraplegia (7.7%), renal failure (15.4%), and respiratory failure (30.8%). No re-interventions or further mortality occurred during follow-up.
Conclusions:
- Single-stage total aortic replacement (TAR) from valve to bifurcation is safe for younger, fit mega-aortic syndrome (MAS) patients.
- This approach yields acceptable mid-term outcomes in experienced centers.
- A single thoracoabdominal incision offers adequate exposure and minimizes surgical trauma.
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