Transposition of an isolated left vertebral artery during aortic arch replacement for Stanford type A aortic dissection.

Background: Isolated left vertebral artery (ILVA) may pose additional difficulties during aortic arch surgical repairs. This study aimed to present our experience in managing ILVA in type A aortic dissection (TAAD) treated with total aortic arch replacement combined with frozen elephant trunk implantation (Sun's procedure) or type II hybrid aortic arch repair. Methods: This was a single-center, retrospective, observational cohort study. A total of 672 patients with TAAD underwent open surgery at the Department of Aortic Surgery, Central China Fuwai Hospital between February 2019 and August 2023. Of these, 5.06% (n=34) had ILVA. The demographics, comorbidities, imaging characteristics, operational intricacies, perioperative outcomes, and follow-up data of these patients were collected and retrospectively analyzed. Results: Out of the 34 patients (25 male, mean age 52.47±12.31 years), 32 underwent the Sun's procedure under moderate hypothermia circulatory arrest, while two patients underwent type II hybrid aortic arch repair under mild hypothermia cardiopulmonary bypass (CPB). ILVA transposition was performed in all cases, resulting in a primary technical success rate of 100%. The average CPB time was 209.79±70.73 min, with an aortic cross-clamping time of 110.65±42.21 min. Unfortunately, three patients died during the perioperative period, of which two died due to gastrointestinal hemorrhage and multiple organ failure and one due to low cardiac output syndrome. No instances of vagus/recurrent laryngeal nerve palsy, Horner syndrome, chylothorax, nor vertebral artery thrombosis were reported. The median follow-up period was 31.69±17.68 (range, 3-56) months. One patient died of colon cancer 3 months postoperatively, while the remaining patients were still alive. All transposed ILVAs remained patent without anastomotic stenosis nor pseudoaneurysm. No aorta-related deaths nor the necessity for aorta-related reintervention arose throughout the follow-up period. Conclusions: Though further cases and extended follow-up periods are necessary, our current data underscore the feasibility, safety, and efficacy of ILVA transposition during the Sun's procedure or type II hybrid aortic arch repair for TAAD.