One-Stage Total or Subtotal Aortic Replacement

Background The goal of total aortic resection surgery is to correct the extensive or multiple sites of aortic pathology, which involves the entire length of the vessel. This study describes our experience in this operation at Fuwai Cardiovascular Hospital. Methods From February 2004 to October 2005, thirteen patients with Marfan syndrome underwent one-stage total or subtotal aortic replacement for aortic dissection or aortic aneurysms. Four patients received subtotal aortic replacement (ascending aorta to the abdominal aorta). Nine patients underwent total aortic replacement (ascending aorta to the aortic bifurcation). Operations were performed under circulatory arrest with profound hypothermia. Patients were opened with a mid-sternotomy and a thoracoabdominal incision. Extracorporeal circulation was instituted with two arterial cannulae and a single venous cannula in the right atrium. During cooling, the ascending aorta or aortic root was replaced. At the nasopharyngeal temperature of 20°C, the aortic arch was replaced with selective antegrade cerebral perfusion. After brain reperfusion, staged aortic occlusions allowed for replacement of descending thoracic and abdominal aorta. Intercostal, visceral, and renal arteries were anastomosed to the graft. Results There was no operative or early postoperative death. One case of postoperative complication was noted for cerebral infarction secondary to embolism. Spinal neurologic deficits did not occur. At the last follow-up, ranging from 4 to 24 months postoperatively, all 13 patients were alive and had good functional status. Conclusions One-stage total or subtotal aortic replacement for treatment of extensive aortic disease is feasible with acceptable surgical risks and satisfactory results. It can eliminate the risk of remnant aortic aneurysm rupture in staged total aortic replacement.