Although a comparative study was not performed, 1-stage surgery consisting of resection of an aneurysm and esophagus, in situ reconstruction of the descending aorta, and omental flap installation provided a better outcome in the treatment for AEF. Bridging TEVAR to the open surgery is a useful adjunct in patients with AEF with hemorrhagic shock. Later reconstruction of the esophagus can be performed in the survivors.

Aggressive direct reperfusion of the carotid artery before the aortic repair may reduce neurological complications in patients with preoperative brain malperfusion secondary to acute aortic dissection.

Early outcomes following graft replacement of Kommerell's diverticulum and in-situ aberrant subclavian artery reconstruction were acceptable. In terms of long-term outcomes, symptomatic improvement and an excellent patency rate among reconstructed aberrant subclavian arteries suggest that in-situ surgical repair is an effective treatment option.

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Objective:We present our open surgical strategies for staged replacement of the thoracic and thoracoabdominal aorta in patients with Marfan syndrome.Methods: Between October 1999 and December 2017, 82 patients with Marfan syndrome underwent 118 aortic repairs. We divided the aorta into 4 segments for categorization: (1) the aortic root, (2) aortic arch, (3) descending thoracic, and (4) abdominal aorta. Procedures were categorized according to the types of surgery. Staged repair was defined as a subsequent operation on a different segment of the aorta after initial repair (n ¼ 111, 94.1%), and reoperation was defined as an operation on the same segment (n ¼ 7, 5.9%). Results:The mean age at initial operation was 41.7 AE 14.9 years. Staged repairs included aortic root replacement (n ¼ 42, 36%), total arch replacement (n ¼ 11, 9.3%), combined aortic root and total arch replacement (n ¼ 13, 11%), descending aorta replacement (n ¼ 4, 3.4%), thoracoabdominal aortic repair (n ¼ 36, 31%), and extensive arch-descending or thoracoabdominal repair (n ¼ 5, 4.2%). Four patients received 3 staged repairs. Operative mortality was 0.8% (1/118). Stroke occurred in 1.7% (2/118), and spinal cord injury occurred in 1.7% (2/117). Overall survival was 95.8 AE 2.4% at 10-years. Twenty-four patients underwent replacement of the whole aorta after 2.5 AE 3.8 years following initial repair.Conclusions: Our strategies for staged replacement of the thoracic and thoracoabdominal aorta in patients with Marfan syndrome resulted in excellent early-and long-term outcomes.