Objective

A two-stage open approach has been for many years the preferred approach to extensive aortic disease involving the aortic arch (AoA) and the descending thoracic aorta (DTA). In recent years hybrid repair has been increasingly adopted to treat these patients. Whilst a single stage open repair is possible in this group of patients, this technique is technically demanding and has not gained popularity over the years. We reviewed our experience in this challenging class of patients.

Methods

Interrogation of a prospectively maintained database to identify 19 consecutive patients who underwent single stage open repair of AoA and DTA. Median [IQR] age was 63 years [41-77 years]. Two patients (10.5%) were affected by connective tissue disease. Six patients (31.8%) had previous sternotomy and two patients (10.5%) previous endovascular treatment of the DTA.

Results

In-hospital mortality and stroke was 5.3%, with no cases of spinal cord injury. Median [IQR] of CPB and cross-clamp time were 277 [216-324] and 128 [84-184], respectively. Rate of prolonged respiratory support and tracheostomy were 57.9% and 47.3%, respectively. At a median follow-up 5.1 years there were no reintervention on the operated aorta and one patient underwent TEVAR of the distal aorta 18 months later.

Conclusion

Single-stage open repair of extensive aortic disease is safe and provides durable results in the long-term, eliminating the risk of stent graft complications but remains technically demanding and is complicated by a higher incidence of respiratory complications. Single-stage open repair of complex AoA and DTA disease should therefore be reserved for young patients, who are less likely to develop postoperative complications and may benefit from a definitive durable long-term repair.