Background: Several recent modifications in technical, operative and perfusion techniques have enabled good operative results and final outcome for patients with aneurysms of the aortic arch. Although surgical procedures for this disease still remain a formidable challenge, availability of improved prosthetic grafts, myocardial protection techniques, brain protection protocols and better blood bank facilities ensure minimal postoperative morbidity and mortality.
Methods: Records of 28 patients operated between January 1994 and January 2001 for aneurysms of the aortic arch were analysed. The study group includes patients with isolated aortic arch aneurysms or with concomitant involvement of the ascending and/or descending thoracic aorta. There were 22 males and 6 females, with an age range of 9–78 years. The mean age at operation was 45.5 years. Etiology included myxomatous degeneration (Marfan’s) in 10; myxomatous degeneration (NonMarfan’s) in 11; atherosclerosis in 6 and traumatic in 1 patient. Graft replacement of the transverse aortic arch with reimplantation of arch vessels was done for 6 patients; Bentall’s procedure with hemiarch replacement for 3 patients; Bentall’s procedure with arch replacement and vessel reimplantation for 4 patients; supracoronary replacement of the ascending aorta plus hemiarch repair in 2 patients; graft replacement of the distal arch alone in 11 patients and ascending, transverse and descending thoracic aorta repair using the elephant trunk technique in 2 patients.
Results: Early hospital mortality was seen in 2 patients with 1 late death. Postoperative complications seen were hemorrhage requiring reoperation in 3 patients, pulmonary insufficiency in 1 patient, renal dysfunction in 1 patient, neurological morbidity in 2 patients and wound sepsis in 2 patients. Mean postoperative hospital stay was 11.4 days. Followup to the present date was completed for all survivors the range being 2–72 months (mean 29.2 months). Majority of the patients reported significant improvement in their symptoms.
Conclusion: With sufficient technical skill and precautions, operative treatment for aneurysms of the aortic arch can be carried out with acceptable mortality and morbidity rates.