Extended Replacement of the Aortic Arch and Descending Aorta

Objective: Reporting our experience of total arch replacement through the left thoracotomy. Patients: From October 1999 to April 2021, 69 patients, aging 62.4 ± 13.7 years (26-84), underwent extensive aortic arch replacement from the ascending aorta, aortic arch, and to the descending aorta. The aneurysm consisted with 2 acute type A dissection, 35 chronic type A dissection, 1 acute type B dissection, 11 chronic type B dissection, 12 non-dissection plus chronic type B dissection, 11 nondissection with mega-aorta, and 4 Kommerell diverticulum. Various segments of aorta were replaced prior to extensive surgery, such as aortic root 7, ascending aorta 25, arch 3, descending aorta 1, thoracoabdominal aorta 1, and AAA 3. Two had ruptured aneurysm, 2 had intraoperative aortic dissection, 3 had graft infection, 2 had tracheotomy, and 1 had cardiac arrest. Methods: Forty-five patients had left posterolateral thoracotomy, 8 had anterolateral left thoracotomy plus partial midsternotomy, 2 had midsternotomy plus left thoracotomy, 2 had right posterolateral thoracotomy, I had Clamshell bilateral thoracotomy, and 13 had left thoracotomy + retroperitoneal approach. All patients underwent total arch and descending aorta replacement. In addition, three had aortic root replacement, 3 had ST junction plication, on had AVR, 12 had reconstruction of the segmental arteries, 13 had replacement of the thoracoabdominal aorta, and 2 had esophagus resection. Sixty-five had antegrade cerebral perfusion and 4 had deep hypothermic circulatory arrest with retrograde cerebral perfusion. Results: There were 4 early deaths (5.8 %). The causes of deaths were preoperative cardiac arrest due to aneurysm rupture, low cardiac output, acute myocardial infarction, and head injury. Conclusion: Extended replacement of the aortic arch and the descending aorta might be useful for the selected patients.