Proximal Aortic Replacement with Ascending–Descending Bypass for a Diffuse Aneurysm: Report of a Case

Abstract

We performed successful ascending-arch aortic replacement and concomitant ascending-to-descending aorta bypass with exclusion of a descending thoracic aneurysm, via median sternotomy, for a ruptured aortic aneurysm involving the entire thoracic aorta. The patient was an 80-year-old man with cardiopulmonary dysfunction and a history of lung tuberculosis. This operation, which has been used for complex descending thoracic aortic lesions such as recoarctation, is a feasible option for a diffuse thoracic aortic aneurysm when single-stage repair is mandatory.

Surgical Approaches to Single-Stage Extended Aortic Repair from the Ascending to the Distal Descending Aorta

“…We have used it in a patient with a history of descending aortic replacement who underwent concomitant replacement of an aortic arch aneurysm and a localized thoracoabdominal aortic aneurysm, 23) or in a patient with diffuse aneurysmal disease and poor pulmonary function who underwent aortic arch replacement and exclusion of the descending thoracic aorta for rupture. 24) In the TEVAR era, such an approach has become less frequently used. Both the pull-through operation and the aneurysm exclusion have a problem of sac growth that is similar to the type-2 endoleak after TEVAR, while these operations are much more invasive than the single-stage hybrid repair combining open surgery with TEVAR.…”

“…We have used it in a patient with a history of descending aortic replacement who underwent concomitant replacement of an aortic arch aneurysm and a localized thoracoabdominal aortic aneurysm, 23) or in a patient with diffuse aneurysmal disease and poor pulmonary function who underwent aortic arch replacement and exclusion of the descending thoracic aorta for rupture. 24) …”