• Asimakis Gkremoutis, Andreas Zierer, Thomas Schmitz-Rixen, Ali El-Sayed Ahmad, Erhard Kaiser, Michael Keese, and Thomas Schmandra.
• Department of Vascular and Endovascular Surgery, University Hospital Frankfurt, Frankfurt am Main, Germany. Electronic address: asimakis.gkremoutis@kgu.de.
• J. Thorac. Cardiovasc. Surg. 2017 Dec 1; 154 (6): 1842-1849.

ObjectiveWe report our experience with a staged hybrid approach for the treatment of extended aortic disease, also known as "mega aortic syndrome."MethodsA total of 15 patients (10 male, 5 female) underwent staged repair of the thoracoabdominal aorta, consisting of 3 separate stages (repair of ascending aorta and aortic arch using the frozen elephant trunk technique and hybrid thoracoabdominal repair with debranching of the renovisceral branches and stent graft implantation).ResultsThe procedure was completed in 14 patients. After the first stage (repair of ascending aorta and aortic arch), no mortality or spinal cord ischemia occurred. One patient required temporary dialysis. After the thoracoabdominal repair, permanent paraplegia developed in 1 patient. One patient died intraoperatively after aneurysm rupture. The in-hospital mortality for the complete repair reached 6.7%. None of the surviving patients required permanent dialysis. Interval aortic events consisted of 1 contained rupture.ConclusionsThe concept of a staged hybrid repair of the mega aortic syndrome is technically feasible. The frozen elephant trunk technique represents an attractive treatment option, offering an adequate landing zone for later thoracoabdominal repair in patients with extended aortic disease. For completion of the repair, a staged hybrid approach with renovisceral debranching and aneurysm exclusion using off-the-shelf stent grafts shows promising results with low surgical morbidity and mortality.Copyright © 2017 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

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