Reconstruction of the isolated left vertebral artery in total aortic arch replacement for type A aortic dissection via a single upper right hemisternotomy approach.

Objectives: The isolated left vertebral artery (ILVA) is a rare congenital abnormality of the branches of the aortic arch. Its presence can influence both the surgical procedure and the prognosis of total aortic arch replacement. The goal of this study was to assess the early postoperative outcomes of ILVA reconstruction performed during total aortic arch replacement via a single upper right hemisternotomy approach.

Methods: From October 2018 to March 2024, patients diagnosed with type A aortic dissection who underwent total aortic arch replacement via a single upper right hemisternotomy at the General Hospital of the Northern Theater Command were included. Based on the presence of ILVA, the patients were divided into the ILVA group and the control group. Patients in the ILVA group underwent intraoperative ILVA reconstruction, and relevant perioperative clinical data were collected and analysed. Inverse probability of treatment weighting was applied to balance the preoperative baseline data.

Results: A total of 516 patients were included in the study. Of these, 34 patients were in the ILVA group, which included 27 males (79.4%) with a mean age of 48.9 ± 12.9 years; the remaining 482 patients were assigned to the control group, which included 360 males (74.7%) with a mean age of 50.5 ± 10.9 years. Following adjustment using the inverse probability of treatment weighting, the incidence of paraplegia was significantly lower in the ILVA group than in the control group (0% vs 2.14%, P = 0.003). Furthermore, the incidence of stroke (3.38% vs 6.55%, P = 0.354) and of in-hospital death (3.23% vs 5.58%, P = 0.454) was similar in both groups.

Conclusions: The research indicates that ILVA reconstruction during total aortic arch replacement via a single upper right hemisternotomy effectively preserved ILVA patency and resulted in excellent early outcomes. Statistically, the incidence of postoperative paraplegia was significantly lower compared to the that in the control group, and no significant differences were observed in deaths or other complications between the 2 groups.

Clinical registration number: The study was approved by the Ethics Committee of the General Hospital of the Northern Theater Command, Shenyang City, China [Y(2024)188].