HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Nicholas T. Kouchoukos Michael C. Mauney Paolo Masetti Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Kouchoukos, N. T. Articles by Castner, C. F. Search for Related Content PubMed PubMed Citation Articles by Kouchoukos, N. T. Articles by Castner, C. F. Related Collections Great vessels

Ann Thorac Surg 2007;83:S811-S814
© 2007 The Society of Thoracic Surgeons

---

Supplement

Optimization of Aortic Arch Replacement With a One-Stage Approach

Division of Cardiovascular and Thoracic Surgery, Missouri Baptist Medical Center, St. Louis, Missouri

^_* Address correspondence to Dr Kouchoukos, Cardiac, Thoracic, and Vascular Surgery, Inc, 3009 N Ballas Rd, Suite 360C, St. Louis, MO 63131. (Email: ntkouch{at}aol.com).

Presented at Aortic Surgery Symposium X, New York, NY, April 27–28, 2006.

BACKGROUND: Staged procedures for extensive aneurysmal disease of the thoracic aorta are associated with a substantial cumulative mortality for the two procedures and death in the interval between, often from aortic rupture. We have used a one-stage approach for operative repair of most, or all, of the thoracic aorta.

METHODS: Sixty-nine patients were treated using a bilateral anterior thoracotomy with transverse sternotomy, hypothermic circulatory arrest, and reperfusion of the arch vessels first to minimize brain ischemia. Forty-two patients had chronic ascending aortic dissections (all but 1 had a previous operation), 24 had degenerative aneurysms, and 3 had chronic descending aortic dissections with proximal extension. The ascending aorta and aortic arch were replaced in all patients combined with resection of various lengths of descending aorta.

RESULTS: In-hospital mortality was 7.2% (5 patients). Morbidity included reoperation for bleeding (13%), mechanical ventilation for more than 72 hours (50%), temporary tracheostomy (13%), and temporary renal dialysis (9%). No patient sustained a stroke. There have been 9 late deaths unrelated to the aortic disease. Four patients have undergone successful reoperation on the aorta for false aneurysm in 1, endocarditis in 1, and progression of disease in 2. Survival at 5 years was 71%.

CONCLUSIONS: The one-stage arch-first technique is a safe and suitable alternative to the two-stage procedure for repair of extensive thoracic aortic disease.

This article has been cited by other articles:

				K. Toda, K. Taniguchi, T. Masai, T. Takahashi, S. Kuki, Y. Sawa, and Osaka Cardiac Surgery Research (OSCAR) Group Arch aneurysm repair with long elephant trunk: a 10-year experience in 111 patients. Ann. Thorac. Surg., July 1, 2009; 88(1): 16 - 22. [Abstract] [Full Text] [PDF]

				R. Di Bartolomeo, L. Di Marco, A. Armaro, D. Marsilli, A. Leone, E. Pilato, and D. Pacini Treatment of complex disease of the thoracic aorta: the frozen elephant trunk technique with the E-vita open prosthesis Eur. J. Cardiothorac. Surg., April 1, 2009; 35(4): 671 - 676. [Abstract] [Full Text] [PDF]

				T. Kim, T. D. Martin, W. A. Lee, P. J. Hess Jr., C. T. Klodell, C. G. Tribble, R. J. Feezor, and T. M. Beaver Evolution in the management of the total thoracic aorta. J. Thorac. Cardiovasc. Surg., March 1, 2009; 137(3): 627 - 634. [Abstract] [Full Text] [PDF]

				Y. Okamoto, M. Matsumoto, and H. Inoue Single-stage repair of extended thoracic aortic aneurysm Interactive CardioVascular and Thoracic Surgery, March 1, 2009; 8(3): 377 - 378. [Abstract] [Full Text] [PDF]

				K. Okada, A. Tanaka, H. Munakata, M. Matsumori, Y. Morimoto, Y. Tanaka, T. Maehara, and Y. Okita Extended replacement of aortic arch aneurysms through left posterolateral thoracotomy Eur. J. Cardiothorac. Surg., February 1, 2009; 35(2): 270 - 275. [Abstract] [Full Text] [PDF]

				V. X. Mosquera, V. Campos, M. Marini, J. V. Valle, I. Cao, D. Gulias, and A. Juffe Hybrid Procedure for Proximal Arch and Descending Aortic Aneurysms Ann. Thorac. Surg., December 1, 2008; 86(6): 1989 - 1991. [Abstract] [Full Text] [PDF]

				J. P. Schwartz, M. Bakhos, A. Patel, S. Botkin, and S. Neragi-Miandoab Impact of pre-existing conditions, age and the length of cardiopulmonary bypass on postoperative outcome after repair of the ascending aorta and aortic arch for aortic aneurysms and dissections Interactive CardioVascular and Thoracic Surgery, October 1, 2008; 7(5): 850 - 854. [Abstract] [Full Text] [PDF]

				T. M. Sundt III, T. A. Orszulak, D. J. Cook, and H. V. Schaff Improving Results of Open Arch Replacement Ann. Thorac. Surg., September 1, 2008; 86(3): 787 - 796. [Abstract] [Full Text] [PDF]

				C. D. Etz, K. A. Plestis, F. A. Kari, M. Luehr, C. A. Bodian, D. Spielvogel, and R. B. Griepp Staged repair of thoracic and thoracoabdominal aortic aneurysms using the elephant trunk technique: a consecutive series of 215 first stage and 120 complete repairs Eur. J. Cardiothorac. Surg., September 1, 2008; 34(3): 605 - 615. [Abstract] [Full Text] [PDF]

				M. Karck and H. Kamiya Progress of the treatment for extended aortic aneurysms; is the frozen elephant trunk technique the next standard in the treatment of complex aortic disease including the arch? Eur. J. Cardiothorac. Surg., June 1, 2008; 33(6): 1007 - 1013. [Abstract] [Full Text] [PDF]

				K. Shimamura, T. Kuratani, G. Matsumiya, M. Kato, Y. Shirakawa, H. Takano, N. Ohta, and Y. Sawa Long-term results of the open stent-grafting technique for extended aortic arch disease. J. Thorac. Cardiovasc. Surg., June 1, 2008; 135(6): 1261 - 1269. [Abstract] [Full Text] [PDF]