REPLACEMENT OF THE ENTIRE THORACIC AORTA IN A SINGLE-STAGE

Aneurysms of the entire thoracic aorta are usually approached in two t o three stages. From 1990 to 1992, we performed one-stage aortic repla cement from the root to the diaphragm in 12 patients (7 men, 5 women; median age, 51 years; range, 49 to 73 years). There were 9 type A diss ections, 5 of which were acute. Five patients underwent aortic valve r econstruction, and 5 had aortic root replacement by Bentall or Cabrol techniques. In 2 patients the innominate artery had to be replaced by a vascular graft separately, in addition to reimplantation of the supr aaortic branches as an island flap into the arch prosthesis. In 5 pati ents a mid-sternotomy was used; in 7 a bilateral transverse thoracotom y. The procedure was performed under deep hypothermic circulatory arre st in all cases (median, 45 minutes). Two patients, both operated on f or an acute dissection, died perioperatively: 1 due to a bronchopneumo nia, 1 because of a thrombosed Cabrol graft to the right coronary arte ry. No bleeding or neurologic complications developed. At a median fol low-up of 14 months (range, 1 to 33 months), all patients discharged f rom the hospital were still alive, Four patients underwent subsequent thoracoabdominal aortic replacement. This experience suggests that com plete thoracic aortic replacement can be performed in a single session , with an operative risk comparable with that of the conventional two- stage approach. The bilateral transverse thoracotomy affords an excell ent exposure. The lack of spinal cord ischemia may be the result of sp inal cord protection with hypothermic circulatory arrest and the open clamp technique.