title: One-stage repair of extensive aortic aneurysms: mid-term results with total or subtotal aortic replacement.
abstract: OBJECTIVE
  To retrospectively analyse the mid-term clinical results of one-stage repair of extensive aortic aneurysms with total or subtotal aortic replacement.
  
  
  METHODS
  From February 2004 to February 2011, 21 patients with extensive aortic aneurysm underwent one-stage total or subtotal aortic replacement for aortic dissection (95.23%) or aortic aneurysms. Operations were performed under circulatory arrest with profound hypothermia. Patients were opened with a mid-sternotomy and a thoraco-abdominal incision. Extracorporeal circulation was instituted as usual. During cooling, the ascending aorta or aortic root was replaced. At the nasopharyngeal temperature of 20°C, the aortic arch was replaced with selective antegrade cerebral perfusion. Staged aortic occlusions allowed for replacement of the descending thoracic and abdominal aorta. T6 to T12 intercostal arteries and L1,L2 lumbar arteries were formed to a neo-intercostal artery in place and were connected to an 8-mm branch for maintaining spinal cord blood perfusion. Visceral arteries were joined into a patch and anastomosed to the end of the main graft.
  
  
  RESULTS
  The early mortality was 4.8% (1 of 21); 1 patient died due to renal failure and multiple organ failure. No patient had spinal cord deficits postoperatively. Two patients had postoperative stroke at Day 5 and 7, respectively. Twenty patients were all alive with good life status during the follow-up period ranging from 18 to 84 months postoperatively. One patient was reoperated with aortic valve replacement because of massive valve insufficiency after 2 years. During the follow-up period, reconstructed intercostal arteries were clogged in 3 patients and dilatated in 2 patients with Marfan syndrome.
  
  
  CONCLUSIONS
  One-stage repair of extensive aortic aneurysms with total or subtotal aortic replacement is safe and effective. It is feasible with acceptable surgical risks and satisfactory results. It can eliminate the risk of remnant aortic aneurysm rupture in staged total aortic replacement and has satisfactory mid-term results.
authors.affiliation: State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China.
authors.forename: Xiao-gang
authors.initials: XG
authors.lastname: Sun
authors.forename: Liang
authors.initials: L
authors.lastname: Zhang
authors.forename: Cun-tao
authors.initials: CT
authors.lastname: Yu
authors.forename: Xiang-yang
authors.initials: XY
authors.lastname: Qian
authors.forename: Qian
authors.initials: Q
authors.lastname: Chang
mesh_terms: D000328:Adult; D001014:Aortic Aneurysm / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D001027:Aortography / Q000379:methods; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D050792:Circulatory Arrest, Deep Hypothermia Induced; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D010477:Perfusion; D011183:Postoperative Complications / Q000401:mortality / Q000601:surgery; D012086:Reoperation; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
keywords: Extensive aortic aneurysms; One-stage repair; Total aortic replacement