title: Early and Late Outcomes After Complete Aortic Replacement.
abstract: BACKGROUND
  The purpose of this report was to analyze our experience with total aortic replacement during a 20-year period.
  
  
  METHODS
  Between 1991 and 2013, 3,012 repairs of the aortic root, ascending, transverse arch, and thoracoabdominal aorta were performed. Of these, we treated 39 patients with complete aortic replacement. Staged repair of the aortic root/ascending/arch and thoracoabdominal segments was used when feasible. Procedures were categorized according to the aorta replaced, whether proximal or distal to the left subclavian artery.
  
  
  RESULTS
  We performed 87 operations (41 ascending and 48 thoracoabdominal repairs) in 39 patients; 2 had combined proximal and distal repairs. Mean age was 52.5 ± 15.9 years, and 17 patients (44%) were women. In addition, 39% (14 of 39) had a history of a connective tissue, and 74% (29 of 39) had a history of aortic dissection. Of the 39 patients, 21 (54%) required two stages for complete replacement, 12 (31%) required three stages, 3 (8%) required four stages, and 3 (8%) required more than five stages. The median time to completion of total aortic repair was 8.7 months (interquartile range, 2 to 71.2 months). No early deaths occurred. No stroke occurred after the proximal repair, and 3 patients (6%) suffered paraplegia after the distal repair. Survival at 5, 10, 15 and 20 years was 70.7%, 57.7%, 54%, and 30%, respectively.
  
  
  CONCLUSIONS
  Complete aortic replacement can be performed with acceptable rates of morbidity and mortality. Most of these patients were younger, had associated dissection, and required multiple stages for completion. As endovascular techniques advance proximally into the ascending aorta and complete endovascular aortic repair comes closer to reality, studies like this will allow comparison.
authors.affiliation: Department of Cardiothoracic and Vascular Surgery, Clinical Science Program, The University of Texas Medical School at Houston and Memorial Hermann Hospital, Houston, Texas. Electronic address: anthony.l.estrera@uth.tmc.edu.
authors.forename: Anthony L
authors.initials: AL
authors.lastname: Estrera
authors.affiliation: Department of Cardiothoracic and Vascular Surgery, Clinical Science Program, The University of Texas Medical School at Houston and Memorial Hermann Hospital, Houston, Texas.
authors.forename: Harleen K
authors.initials: HK
authors.lastname: Sandhu
authors.affiliation: Department of Cardiothoracic and Vascular Surgery, Clinical Science Program, The University of Texas Medical School at Houston and Memorial Hermann Hospital, Houston, Texas.
authors.forename: Rana O
authors.initials: RO
authors.lastname: Afifi
authors.affiliation: Department of Cardiothoracic and Vascular Surgery, Clinical Science Program, The University of Texas Medical School at Houston and Memorial Hermann Hospital, Houston, Texas.
authors.forename: Tom C
authors.initials: TC
authors.lastname: Nguyen
authors.affiliation: Department of Cardiothoracic and Vascular Surgery, Clinical Science Program, The University of Texas Medical School at Houston and Memorial Hermann Hospital, Houston, Texas.
authors.forename: Kristofer M
authors.initials: KM
authors.lastname: Charlton-Ouw
authors.affiliation: Department of Cardiothoracic and Vascular Surgery, Clinical Science Program, The University of Texas Medical School at Houston and Memorial Hermann Hospital, Houston, Texas.
authors.forename: Ali
authors.initials: A
authors.lastname: Azizzadeh
authors.affiliation: Department of Cardiothoracic and Vascular Surgery, Clinical Science Program, The University of Texas Medical School at Houston and Memorial Hermann Hospital, Houston, Texas.
authors.forename: Charles C
authors.initials: CC
authors.lastname: Miller
authors.affiliation: Department of Cardiothoracic and Vascular Surgery, Clinical Science Program, The University of Texas Medical School at Houston and Memorial Hermann Hospital, Houston, Texas.
authors.forename: Hazim J
authors.initials: HJ
authors.lastname: Safi
mesh_terms: D001011:Aorta / Q000601:surgery*; D001014:Aortic Aneurysm / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000379:methods