Combined single-stage approach for repair of extensive aortic pathologies - our initial experience

Management of aortic pathologies affecting the arch and proximal descending thoracic aorta, with complex anatomical features, remains a formidable clinical challenge. We report our surgical experience using a single-stage combined approach for such repairs using a simultaneous anterolateral thoracotomy and midline sternotomy and its benefits. This is a retrospective, single-centre experience of 17 patients from January 2021 to September 2023. The entire thoracic aorta is well visualised and excellent access to the arch vessels and even distal limits of the disease is achieved. In this series, there were no incidents of stroke, renal failure, or spinal cord ischaemia. There was no mortality. One patient needed a reintervention, and another developed chylothorax which needed surgical drainage. Three patients had recurrent laryngeal nerve paresis that resolved over time. One patient had a transient posterior cerebral artery infarct that responded to conservative management. Mean cardiopulmonary bypass time was 247 min, with a mean of 183 min aortic cross-clamp time. Adequate neurological protection was usually achieved by low flow circulation. All patients are doing well, without any symptoms, on follow-up. While the prospect of utilizing two long incisions may initially raise concerns about increased morbidity, the substantial advantages of this approach in terms of enhanced visualization and access, ensuring proper distal body perfusion, and facilitating precise surgical techniques far outweigh the associated complications. Long-term data of a large cohort of such patients is needed to arrive at a definite conclusion.