Reconstruction of the supra-aortic trunks

Objective: To review our 10-year experience of reconstruction of the supra- aortic trunks. Design: Retrospective study. Setting: Teaching hospital, The Netherlands. Subjects: 47 patients who required reconstruction of the supra-aortic trunk s for stenotic or occlusive disease between April 1987 and May 1997. Interventions: Right-sided bifurcation graft through a sternotomy (n = 25), left-sided thoracotomy (n = 1), and extra-anatomic bypass (n = 21). Main outcome measures: Morbidity, mortality, and long term patency. Results: 3 patients died (6%); 7 (15%) developed major complications (leak from the brachiocephalic stump, n = 2, and acute occlusion of the bypass gr aft, n = 5) all of which were successfully treated by immediate reoperation ; and 9 (19%) developed minor complications, all of which resolved within 3 months. The median follow up was 36 months (range 1-108), and the 3-year p atency rate was 80%. No patient died during the follow up period, but a fur ther 3 were lost to follow up. The remaining 41 were all assessed by duplex scanning or angiography, and 3 required further operation for recurrent sy mptoms; 33 remained completely free of symptoms. Conclusion: Symptomatic stenotic or occlusive lesions of the supra-aortic t runks can be treated with acceptable morbidity and mortality, giving long t erm benefit to patients.