OBJECTIVETo summarize the experience of one-stage total and subtotal aortic replacement for aneurysm evolving the entire aorta and show the midterm results of the operation.

METHODSFrom February 2004 to July 2008, 22 patients (17 men and 5 women, age ranged from 19 to 47 years old) underwent one-stage total or subtotal aortic replacement under deep hypothermic circulatory arrest and selective antegrade cerebral perfusion. Seven patients received subtotal aortic replacement (from the aortic valve to the abdominal aorta). Fifteen patients underwent total aortic replacement (from the aortic valve to the aortic bifurcation). Patients were opened with a mid-sternotomy and a thoracoabdominal incision. First, the ascending aorta was replaced; following which the aortic arch was reconstructed. Finally, the thoracoabdominal aorta was fully replaced.

RESULTSThirty-day mortality was 4.5% (1/22). One patient died of multiple organ failure 11 days postoperatively. Two patients had cerebral infarction secondary to embolism. Spinal neurological deficits didn't occur. Twenty-one patients survived the operation and were followed up for 3 to 56 months (35.0 +/- 16.9 months). There was no late death. One patient received aortic valve replacement due to aortic valve regurgitation one year after David and total aortic replacement.

CONCLUSIONOne-stage total and subtotal aortic replacement is an effective operation for aneurysm evolving the whole length of the aorta with acceptable mortality and morbidity. Midterm follow-up showed satisfactory results.