Outcomes of Ascending Aorta-Based Trans-sternal Great Vessel Reconstruction

Abstract

Background: Ascending aorta-based trans-sternal great vessel reconstruction (AA-TGVR) is an uncommonly performed procedure in the modern endovascular era. This approach serves an important role for patients with great vessel occlusive disease (GVOD) that is extensive, calcific in nature, and involves the arch or multiple great vessels. It is also indicated in preparation for zone 0 thoracic endovascular repair (TEVAR). The aim of this study is to evaluate our single-center outcomes with AA-TGVR.

Methods: A retrospective review was conducted of patients undergoing AA-TGVR between January 1, 2015 and August 31, 2025. Patients undergoing concomitant ascending aortic repair for type A aortic dissections and great vessel reimplantations were excluded. The primary outcome was 30-day mortality, and secondary outcomes included 30-day stroke, reintervention and late (>30 day) stroke, mortality, and reintervention.

Results: A total of 24 patients were included for review. Patients were grouped according to pathology with 11 in the nonocclusive group (45.8%) and 13 in the GVOD group (54.2%). The mean age was 68.2 years and the majority of patients were female at 70.8%. A total of 50 vessel reconstructions via bypass grafting were performed and extracorporeal circulatory support was used as an adjunct in 11 patients (45.8%). The primary outcome of 30-day mortality was 4.2%. The 30-day stroke rate and 30-day reintervention rate were both 4.2%. Late stroke and mortality rate were 4.2% and 17.4%, respectively. There were 6 late reinterventions with no significant difference between groups.

Conclusion: AA-TGVR remains a safe and effective procedure for both occlusive and nonocclusive disease of the great vessels not amenable to endovascular approaches due to extensive innominate or multivessel disease and for zone 0 TEVAR. ECS may serve as an important adjunct to provide antegrade perfusion to the brain during the procedure and mitigate cerebral ischemia risks.