Open ascending aorta replacement combined with fenestrated total aortic arch stenting

Area of Science:

• Cardiovascular Surgery
• Vascular Surgery
• Interventional Cardiology

Background:

• Stanford type A aortic dissection presents complex surgical challenges.
• Traditional open repair of the aortic arch can be associated with significant morbidity and mortality.
• There is a need for innovative techniques to manage extensive aortic arch involvement.

Purpose of the Study:

• To report a novel hybrid technique for Stanford type A aortic dissection.
• To describe the replacement of the ascending aorta and implantation of a fenestrated stent-graft for the entire aortic arch.
• To analyze the clinical experience and outcomes of this hybrid approach.

Main Methods:

• Retrospective single-center study of 31 patients with Stanford type A aortic dissection.
• Open ascending aorta replacement without hypothermia or circulatory arrest.
• Total endovascular arch repair using self-modified stent-grafts to preserve native branch vessels.

Main Results:

• 100% surgical technical success rate.
• Low early mortality (3.22%) with one death due to cerebral hemorrhage.
• Significant rates of postoperative complications including renal insufficiency requiring hemodialysis (16.13%) and prolonged mechanical ventilation (19.36%).
• Follow-up in 83.33% of patients revealed 8.00% mortality and 8.00% reoperation rate.

Conclusions:

• Single-stage hybrid repair of ascending aorta and total aortic arch offers satisfactory early outcomes for Stanford type A aortic dissection.
• This hybrid strategy is a potentially valuable treatment option for patients unsuitable for conventional open total arch repair.