Arch-First Technique for Extensive Thoracic Aortic Replacement: A Case Series of Patients With Complex Thoracic Aortic Disease
Abstract
Case series Patients: Male, 24-year-old • Male, 72-year-old • Male, 73-year-old • Male, 24-year-old • Male, 50-year-old • Male, 50-year-old • Female, 69-year-old Final Diagnosis: Aortic arch aneurysm Symptoms: Asymptomatic Clinical Procedure: — Specialty: Cardiac surgery Objective: Rare disease Background Given its associations with high morbidity and mortality, type A aortic dissection requires urgent surgical intervention. Patients with Marfan syndrome present additional complexity due to underlying connective tissue abnormalities that warrant multiple thoracic aortic operations. The “arch-first” technique was developed to allow single-stage open extensive replacement of the thoracic aorta while maintaining continuous antegrade cerebral perfusion, thereby minimizing brain ischemia. In the current endovascular era, the frozen elephant trunk – a hybrid technique combining a conventional surgical graft for arch reconstruction with an integrated distal stent-graft – has gained popularity in management of these cases, displacing extensive open approaches. However, for specific patient populations, the arch-first technique remains a suitable approach. Case Reports This report describes 6 patients (5 men, 1 woman; aged 24–73 years) who were treated between June 2022 and June 2025 through application of the arch-first technique in complex clinical scenarios, highlighting its benefit in providing effective single-stage management of extensive thoracic aortic pathology. Although no…
How strong is the evidence?
Evidence Hub reads this as a case series, done in people. Its evidence level is 5 of 5 (Very low · case / narrative / animal / in vitro / in silico). Case reports, narrative reviews, and animal, cell or computer-model studies give the weakest evidence for human health. Reported size: 6 participants or records.
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