Outcomes of Ascending Aorta-Based Trans-sternal Great Vessel Reconstruction

Area of Science:

• Cardiovascular Surgery
• Vascular Surgery
• Thoracic Surgery

Background:

• Ascending aorta-based trans-sternal great vessel reconstruction (AA-TGVR) is an uncommon procedure in the current endovascular era.
• It is crucial for extensive, calcific great vessel occlusive disease (GVOD) involving the arch or multiple vessels.
• AA-TGVR is also indicated for patients requiring zone 0 thoracic endovascular repair (TEVAR).

Purpose of the Study:

• To evaluate the single-center outcomes of AA-TGVR.
• Assess the safety and efficacy of AA-TGVR for specific complex vascular pathologies.
• Determine the procedural success and complication rates associated with AA-TGVR.

Main Methods:

• Retrospective review of patients undergoing AA-TGVR from 1/1/2015 to 8/31/2025.
• Exclusion of patients with Type A Aortic Dissections and great vessel reimplantations.
• Primary outcome: 30-day mortality; Secondary outcomes: 30-day and late stroke, reintervention, and mortality.

Main Results:

• 24 patients included: 11 non-occlusive (45.8%), 13 GVOD (54.2%). Mean age 68.2 years, 70.8% female.
• 50 bypass grafts performed; Extracorporeal Circulatory Support (ECS) used in 45.8%.
• 30-day mortality: 4.2%; 30-day stroke/reintervention: 4.2%. Late stroke: 4.2%; Late mortality: 17.4%; 6 late reinterventions.

Conclusions:

• AA-TGVR is a safe and effective option for complex occlusive and non-occlusive great vessel disease unsuitable for endovascular repair.
• It is also a viable approach for zone 0 TEVAR preparation.
• Extracorporeal circulatory support (ECS) may mitigate cerebral ischemia risks by providing antegrade brain perfusion.