title: One-stage repair of extensive thoracic aortic disease.
abstract: OBJECTIVE
  Staged procedures for extensive aneurysmal disease of the thoracic aorta are associated with substantial cumulative mortality for the 2 procedures and death in the interval in between, often from aortic rupture. We have used a 1-stage procedure for operative repair of most, or all, of the thoracic aorta.
  
  
  METHODS
  Ninety-five patients were treated using a bilateral anterior thoracotomy with transverse sternotomy, hypothermic circulatory arrest, and reperfusion of the arch vessels first to minimize brain ischemia. Fifty-six patients had chronic type A aortic dissections (all but 2 patients had a previous operation), 36 patients had degenerative aneurysms, and 3 patients had chronic type B aortic dissections with proximal extension. The ascending aorta and aortic arch were replaced in all patients combined with resection of varying lengths of descending aorta.
  
  
  RESULTS
  In-hospital mortality was 8.4% (8 patients). Morbidity included reoperation for bleeding (11%), mechanical ventilation for more than 72 hours (48%), tracheostomy (17%), and renal dialysis (8%). Stroke occurred in 1 patient (1%). Seven of the 93 operative survivors (7.6%) have undergone successful reoperation on the graft (4 patients) or the contiguous aorta (3 patients).
  
  
  CONCLUSIONS
  The 1-stage, arch-first technique is a safe and suitable alternative to 2-stage procedures for repair of thoracic aortic disease. Its effectiveness relative to more recently developed hybrid procedures awaits further analysis of long-term performance.
authors.affiliation: Division of Cardiovascular and Thoracic Surgery, Missouri Baptist Medical Center, BJC Healthcare System, St Louis, MO, USA. ntkouch@aol.com
authors.forename: Nicholas T
authors.initials: NT
authors.lastname: Kouchoukos
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000784:Aortic Dissection / Q000401:mortality / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000401:mortality / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000401:mortality; D016009:Chi-Square Distribution; D002908:Chronic Disease; D005260:Female; D006324:Heart Arrest, Induced; D017052:Hospital Mortality; D006801:Humans; D007036:Hypothermia, Induced; D008297:Male; D008875:Middle Aged; D008923:Missouri; D019106:Postoperative Hemorrhage / Q000209:etiology / Q000601:surgery; D006435:Renal Dialysis; D012086:Reoperation; D015424:Reperfusion; D012121:Respiration, Artificial; D056346:Sternotomy; D020521:Stroke / Q000209:etiology; D013908:Thoracotomy; D013997:Time Factors; D014139:Tracheostomy; D016896:Treatment Outcome; D055815:Young Adult