Case Series
Clinical Outcomes and Technical Considerations in the Surgical and Endovascular Management of Ascending Aortic and Aortic Arch Aneurysms: A Case Series
PR04-PR11
Correspondence
B Nembian Raja Rajan,
601, B-Block Medical Staff Quarters, SRM Nagar, Potheri, Chennai-603203, Tamil Nadu, India.
E-mail: nembianr@srmist.edu.in
Aneurysms of the ascending aorta and aortic arch represent one of the most surgically challenging domains in cardiothoracic practice. Contemporary management requires a hybrid strategy integrating conventional open surgery, staged procedures, and Thoracic Endovascular Aortic Repair (TEVAR). This case series presents the institutional experience with six patients who underwent diverse surgical and endovascular interventions for aortic aneurysmal disease, highlighting surgical technique, perioperative complexity, and clinical outcomes. Six patients (age range 30-65 years; four males, two females) presented with aortic pathologies including ascending aortic aneurysm, aortic arch aneurysm, descending thoracic aortic aneurysm, and chronic Type B aortic dissection. Procedures included Aortic Valve Replacement (AVR) with ascending aorta replacement (Dacron graft), total arch replacement with the elephant trunk technique followed by staged TEVAR, carotid artery debranching with staged TEVAR, hemiarch replacement with innominate artery re-implantation, and emergency aortic debranching with TEVAR for complicated dissection. Five of six patients were discharged in haemodynamically stable condition with satisfactory postoperative recovery and continued well-being confirmed at outpatient follow-up. One patient died due to retrograde Type A aortic dissection with coronary extension and cardiac tamponade on postoperative day 10. A multidisciplinary, heart-team-based approach with careful patient selection, staged procedural planning, and individualised intraoperative strategy achieves acceptable outcomes even in complex aortic pathologies. TEVAR combined with surgical debranching provides a viable hybrid alternative in high-risk patients. Mortality risk persists in retrograde dissection, underscoring the need for vigilant surveillance.