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.