Efficacy analysis of isolated left vertebral artery reconstruction in total aortic arch replacement via single upper hemisternotomy approach_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

WANG Lu , GE Yuguang , YANG Zhonglu , LIU Yu , XIA Lin , LIU Zhishuo , JIANG Hui

Department of Cardiovascular Surgery, General Hospital of Northern Theater Command, Shenyang, 110016, Liaoning, P. R. China;

Corresponding author：

Keywords：

Aortic dissection; isolated left vertebral artery; total aortic arch replacement; upper hemisternotomy

DOI：

10.7507/1007-4848.202405001

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Objective To investigate the surgical approach and efficacy of reconstruction of the isolated left vertebral artery (ILVA) in single upper hemisternotomy for total aortic arch replacement. Methods From March 2017 to October 2023, patients who underwent total aortic arch replacement under single upper hemisternotomy in General Hospital of Northern Theater Command were selected. According to the presence of ILVA, they were divided into a conventional group and an ILVA group. All the ILVA group underwent intraoperative ILVA reconstruction. The perioperative clinical data between two groups were compared. Results A total of 504 patients were collected, including 471 males and 31 females, with an average age of 50.4±11.4 years. There was no increase in the duration of cardiopulmonary bypass or postoperative hospitalization in the ILVA group (n=31) compared to the conventional group (n=473), and the rates of perioperative complications and in-hospital mortality were not significantly different between the two groups. There were 2 (6.45%) patients of acute cerebral infarction and 2 (6.45%) patients of perioperative death in the ILVA group, with no spinal cord injuries. Conclusion ILVA reconstruction during total aortic arch replacement in single upper hemisternotomy is feasible, safe, and effective, and prioritizing off pump ILVA-left common carotid artery transposition.

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2.	Bossone E, LaBounty TM, Eagle KA. Acute aortic syndromes: Diagnosis and management, an update. Eur Heart J, 2018, 39(9): 739-749.
3.	Zhu Y, Lingala B, Baiocchi M, et al. Type A aortic dissection-experience over 5 decades: JACC historical breakthroughs in perspective. J Am Coll Cardiol, 2020, 76(14): 1703-1713.
4.	Chiu P, Trojan J, Tsou S, et al. Limited root repair in acute type A aortic dissection is safe but results in increased risk of reoperation. J Thorac Cardiovasc Surg, 2018, 155(1): 1-7.
5.	Açar G, Çiçekcibaşı AE, Uysal E, et al. Anatomical variations of the aortic arch branching pattern using CT angiography: A proposal for a different morphological classification with clinical relevance. Anat Sci Int, 2022, 97(1): 65-78.
6.	Dumfarth J, Chou AS, Ziganshin BA, et al. Atypical aortic arch branching variants: A novel marker for thoracic aortic disease. J Thorac Cardiovasc Surg, 2015, 149(6): 1586-1592.
7.	Piffaretti G, Gelpi G, Tadiello M, et al. Transposition of the left vertebral artery during endovascular stent-graft repair of the aortic arch. J Thorac Cardiovasc Surg, 2020, 159(6): 2189-2198.
8.	Pape LA, Awais M, Woznicki EM, et al. Presentation, diagnosis, and outcomes of acute aortic dissection: 17-year trends from the International Registry of Acute Aortic Dissection. J Am Coll Cardiol, 2015, 66(4): 350-358.
9.	Sonwani NS, Thakur KS, Ateriya N, et al. An unusual origin of the left vertebral artery: A case report. Cureus, 2023, 15(8): e43824.
10.	Rylski B, Schofer F, Beyersdorf F, et al. Aortic arch anatomy in candidates for aortic arch repair. Semin Thorac Cardiovasc Surg, 2022, Spring,34(1): 19-26.
11.	Rangel-Castilla L, Kalani MY, Cronk K, et al. Vertebral artery transposition for revascularization of the posterior circulation: A critical assessment of temporary and permanent complications and outcomes. J Neurosurg, 2015, 122(3): 671-677.
12.	Isselbacher EM, Preventza O, Hamilton Black J, et al. 2022 ACC/AHA guideline for the diagnosis and management of aortic disease: A report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines. Circulation, 2022, 146(24): e334-e482.
13.	Yang G, Chen H, Sun G, et al. Transposition of isolated left vertebral artery in hybrid thoracic endovascular aortic repair. Front Cardiovasc Med, 2021 Dec 14: 8: 783656.
14.	Shen P, Li D, Wu Z, et al. Physician-modified fenestration or in situ fenestration for preservation of isolated left vertebral artery in thoracic endovascular aortic repair. Front Cardiovasc Med, 2023, 10: 1055549.
15.	Li Q, Li J, Lv F, et al. A multidetector CT angiography study of variations in the circle of Willis in a Chinese population. J Clin Neurosci, 2011, 18(3): 379-383.
16.	Zuo Y, Zhou ZC, Ge JJ. Prior reconstruction of an isolated left vertebral artery for Stanford type A aortic dissection. Eur J Cardiothorac Surg, 2021, 59(6): 1339-1341.
17.	Suzuki K, Kazui T, Bashar AH, et al. Total aortic arch replacement in patients with arch vessel anomalies. Ann Thorac Surg, 2006, 81(6): 2079-2083.
18.	Zhu J, Tong G, Zhuang D, et al. Surgical treatment strategies for patients with type A aortic dissection involving arch anomalies. Front Cardiovasc Med, 2022 Sep 13: 9: 979431.
19.	Yamashiro S, Kuniyoshi Y, Arakaki K, et al. Total arch replacement with associated anomaly of the left vertebral artery. Ann Thorac Cardiovasc Surg, 2010, 16(3): 216-219.
20.	Qi R, Sun L, Zhu J, et al. Total arch replacement in patients with aortic dissection with an isolated left vertebral artery. Ann Thorac Surg, 2013, 95(1): 36-40.
21.	Ding H, Zhu Y, Wang H, et al. Management of type B aortic dissection with an isolated left vertebral artery. J Vasc Surg, 2019, 70(4): 1065-1071.
22.	Yang Z, Jiang H, Liu Y, et al. Both J- and L-shaped upper hemisternotomy approaches are suitable for total arch replacement with frozen elephant trunk in patients with Type A dissection. Front Cardiovasc Med, 2022, 9: 998139.
23.	Jiang H, Liu Y, Yang Z, et al. Total arch replacement via single upper-hemisternotomy approach in patients with type A dissection. Ann Thorac Surg, 2020, 109(5): 1394-1399.

1. Evangelista A, Isselbacher EM, Bossone E, et al. Insights from the international registry of acute aortic dissection: A 20-year experience of collaborative clinical research. Circulation, 2018, 137(17): 1846-1860.
2. Bossone E, LaBounty TM, Eagle KA. Acute aortic syndromes: Diagnosis and management, an update. Eur Heart J, 2018, 39(9): 739-749.
3. Zhu Y, Lingala B, Baiocchi M, et al. Type A aortic dissection-experience over 5 decades: JACC historical breakthroughs in perspective. J Am Coll Cardiol, 2020, 76(14): 1703-1713.
4. Chiu P, Trojan J, Tsou S, et al. Limited root repair in acute type A aortic dissection is safe but results in increased risk of reoperation. J Thorac Cardiovasc Surg, 2018, 155(1): 1-7.
5. Açar G, Çiçekcibaşı AE, Uysal E, et al. Anatomical variations of the aortic arch branching pattern using CT angiography: A proposal for a different morphological classification with clinical relevance. Anat Sci Int, 2022, 97(1): 65-78.
6. Dumfarth J, Chou AS, Ziganshin BA, et al. Atypical aortic arch branching variants: A novel marker for thoracic aortic disease. J Thorac Cardiovasc Surg, 2015, 149(6): 1586-1592.
7. Piffaretti G, Gelpi G, Tadiello M, et al. Transposition of the left vertebral artery during endovascular stent-graft repair of the aortic arch. J Thorac Cardiovasc Surg, 2020, 159(6): 2189-2198.
8. Pape LA, Awais M, Woznicki EM, et al. Presentation, diagnosis, and outcomes of acute aortic dissection: 17-year trends from the International Registry of Acute Aortic Dissection. J Am Coll Cardiol, 2015, 66(4): 350-358.
9. Sonwani NS, Thakur KS, Ateriya N, et al. An unusual origin of the left vertebral artery: A case report. Cureus, 2023, 15(8): e43824.
10. Rylski B, Schofer F, Beyersdorf F, et al. Aortic arch anatomy in candidates for aortic arch repair. Semin Thorac Cardiovasc Surg, 2022, Spring,34(1): 19-26.
11. Rangel-Castilla L, Kalani MY, Cronk K, et al. Vertebral artery transposition for revascularization of the posterior circulation: A critical assessment of temporary and permanent complications and outcomes. J Neurosurg, 2015, 122(3): 671-677.
12. Isselbacher EM, Preventza O, Hamilton Black J, et al. 2022 ACC/AHA guideline for the diagnosis and management of aortic disease: A report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines. Circulation, 2022, 146(24): e334-e482.
13. Yang G, Chen H, Sun G, et al. Transposition of isolated left vertebral artery in hybrid thoracic endovascular aortic repair. Front Cardiovasc Med, 2021 Dec 14: 8: 783656.
14. Shen P, Li D, Wu Z, et al. Physician-modified fenestration or in situ fenestration for preservation of isolated left vertebral artery in thoracic endovascular aortic repair. Front Cardiovasc Med, 2023, 10: 1055549.
15. Li Q, Li J, Lv F, et al. A multidetector CT angiography study of variations in the circle of Willis in a Chinese population. J Clin Neurosci, 2011, 18(3): 379-383.
16. Zuo Y, Zhou ZC, Ge JJ. Prior reconstruction of an isolated left vertebral artery for Stanford type A aortic dissection. Eur J Cardiothorac Surg, 2021, 59(6): 1339-1341.
17. Suzuki K, Kazui T, Bashar AH, et al. Total aortic arch replacement in patients with arch vessel anomalies. Ann Thorac Surg, 2006, 81(6): 2079-2083.
18. Zhu J, Tong G, Zhuang D, et al. Surgical treatment strategies for patients with type A aortic dissection involving arch anomalies. Front Cardiovasc Med, 2022 Sep 13: 9: 979431.
19. Yamashiro S, Kuniyoshi Y, Arakaki K, et al. Total arch replacement with associated anomaly of the left vertebral artery. Ann Thorac Cardiovasc Surg, 2010, 16(3): 216-219.
20. Qi R, Sun L, Zhu J, et al. Total arch replacement in patients with aortic dissection with an isolated left vertebral artery. Ann Thorac Surg, 2013, 95(1): 36-40.
21. Ding H, Zhu Y, Wang H, et al. Management of type B aortic dissection with an isolated left vertebral artery. J Vasc Surg, 2019, 70(4): 1065-1071.
22. Yang Z, Jiang H, Liu Y, et al. Both J- and L-shaped upper hemisternotomy approaches are suitable for total arch replacement with frozen elephant trunk in patients with Type A dissection. Front Cardiovasc Med, 2022, 9: 998139.
23. Jiang H, Liu Y, Yang Z, et al. Total arch replacement via single upper-hemisternotomy approach in patients with type A dissection. Ann Thorac Surg, 2020, 109(5): 1394-1399.

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