ONE-STAGE INTRATHORACIC REPAIR OF EXTENDED AORTIC-ANEURYSMS

Aneurysms of the entire thoracic aorta are usually approached in two t o three stages. From 1990 to 1994, we performed one-stage aortic repla cement from the root to the diaphragm in 16 patients (8 men and 8 wome n with a mean age of 55.7 years, range 49 to 73). There were 11 type A dissections, 7 of which were acute. Six patients underwent aortic val ve reconstruction; seven had aortic root replacement by Bentall or Cab rol techniques. In two cases, the innominate artery had to be replaced by a vascular graft separately in addition to reimplantation of the s upraaortic branches as an island flap into the arch prosthesis. In eig ht cases, a median sternotomy was used; eight had a bilateral transver se thoracotomy. The procedure was performed under deep hypothermic cir culatory arrest in all cases (mean duration 50.5 min, range 38 to 62 m in). Two patients, both operated upon for an acute dissection, expired perioperatively: one due to a bronchopneumonia, and one because of a thrombosed Cabrol graft to the right coronary artery. No patient devel oped bleeding or neurological complications. At a mean follow-up of 26 .9 months (1 to 50 months), all patients discharged from the hospital were still alive. Four patients underwent subsequent thoracoabdominal aortic replacement. This experience suggests that complete thoracic ao rtic replacement can be performed in a single session with an operativ e risk comparable to that of the conventional two-stage approach. The bilateral transverse thoracotomy affords excellent exposure. The lack of spinal cord ischemia may be the result of spinal cord protection wi th hypothermic circulatory arrest and use of the open-clamp technique.