Staged open ascending aortic replacement and endovascular total arch repair using a three-inner-branch...

This report describes a single-admission, two-stage hybrid approach for chronic postdissection aneurysmal degeneration of the ascending aorta and aortic arch. Stage 1 consists of open ascending aortic replacement without deep hypothermic circulatory arrest. Stage 2 uses a three-inner-branch physician-modified endograft with novel features for total arch repair, relying on the surgical graft from stage 1 as the proximal landing zone. To minimize cardiac pulsatility-induced motion, atriocaval occlusion was used, alongside a repurposed thoracic branch endoprosthesis side branch for secure innominate artery sealing. This less invasive strategy simplifies arch reconstruction and broadens treatment options for high-risk patients with postdissection multisegment aneurysms.