Case Report: Single-Stage Open Repair for Complex Aortic Anomalies at West China Hospital
Case Overview
Recently, the surgical team led by Dr. Zhenghua Xiao at the Department of Cardiovascular Surgery, West China Hospital of Sichuan University, successfully performed a single-stage open repair on a 28-year-old male with severe complex aortic lesions. The concurrent presence of a Kommerell diverticulum, aortic root aneurysm, severe aortic regurgitation, right aortic arch, and aberrant left subclavian artery is extremely rare globally.
Treatment Decision & Technical Pathway
Addressing the unique anatomical structure of this young patient, the team evaluated the limitations of endovascular hybrid interventions. To ensure the patient's long-term quality of life and avoid the uncertainty of stent-grafting, the team executed a "single-stage combined-incision open repair" to resolve all aortic pathologies definitively in one setting.
Surgical Execution & Technical Details
The comprehensive procedure included: Bentall procedure + Kommerell diverticulum resection + replacement of the distal right aortic arch and descending aorta + reconstruction of the aberrant left subclavian artery.
- The procedure was performed under deep hypothermic circulatory arrest (DHCA) with retrograde cerebral perfusion to ensure neurological and visceral protection.
- The team navigated the extreme difficulties of deep anatomical exposure (posterior to the esophagus), utilizing interrupted suturing techniques to complete the in-situ reconstruction of the descending aorta and the aberrant left subclavian artery.
Clinical Outcome & Conclusion
Postoperative imaging confirmed the complete resection of the aortic root aneurysm and diverticulum, along with excellent prosthetic valve function. The patient recovered smoothly and has been discharged. This case provides a valuable clinical reference, demonstrating the feasibility and definitive efficacy of a single-stage open surgical approach for managing concurrent complex congenital and acquired aortic pathologies.