Open ascending aorta replacement combined with fenestrated total aortic arch stenting

Objective

The aim of this retrospective single-center study was to report a novel hybrid technique of replacement of the ascending aorta and implantation of fenestrated stent-graft of the entire aortic arch for Stanford type A aortic dissection and to analyze clinical experience and outcomes.

Methods

From January 2019 to January 2023 in Tongji hospital, 31 cases (26 men and 5 women, mean age 56.06 ± 10.34 years) with Stanford type A aortic dissection underwent open ascending aorta replacement combined with total endovascular arch repair. All patients underwent ascending aorta replacement without hypothermia or circulatory arrest. Arch intervention was performed with self-modified stent-grafts to preserve the aortic arch native branches.

Result

The surgical technical success rate was 100% in all patients. One (3.22%) patient died after surgery due to cerebral hemorrhage. Five (16.13%) patients with preoperative renal insufficiency required hemodialysis. Six (19.36%) patients were on mechanical ventilation for more than 48 hours. One patient was found to have an endoleak (Type IV). There were 25 (83.33%) patients who underwent follow-up with a median follow-up time of 14.00 months (range, 6.50-28.50 months). Two (8.00%) of them died (1 of infectious shock and the other of respiratory arrest) and 2 (8.00%) underwent aortic reoperation.

Conclusions

Single-stage open ascending aortic replacement combined with the total aortic endovascular arch intervention may provide satisfactory early outcomes in Stanford type A aortic dissection. This strategy may be valuable for a subgroup of patients deemed inappropriate candidates for open classic full arch repair.