Reconstruction of isolated left vertebral artery in total aortic arch replacement of type A aortic dissection via single upper right hemisternotomy approach

Abstract Objectives The isolated left vertebral artery (ILVA) is a rare congenital abnormality of the branches of the aortic arch. Its presence can influence both the surgical procedure and the prognosis of total aortic arch replacement. This study aimed to assess the early postoperative outcomes of ILVA reconstruction performed during total aortic arch replacement via a single upper right hemisternotomy approach. Methods From October 2018 to March 2024, patients diagnosed with type A aortic dissection (TAAD) who underwent total aortic arch replacement via single upper right hemisternotomy at the General Hospital of Northern Theater Command were included. Based on the presence of ILVA, the patients were divided into the control group and the ILVA group. Patients in the ILVA group underwent intraoperative ILVA reconstruction, and relevant perioperative clinical data were collected and analyzed. Inverse probability of treatment weighting (IPTW) was applied to balance the preoperative baseline data. Results A total of 516 patients were included in the study. Of these, 34 patients were in the ILVA group, comprising 27 males (79.4%) with a mean age of 48.9 ± 12.9 years, while the remaining 482 patients were assigned to the control group, which included 360 males (74.7%) with a mean age of 50.5 ± 10.9 years. Following adjustment using IPTW, the incidence of paraplegia was significantly lower in the ILVA group than in the control group (0% vs. 2.14%, p = 0.003). Furthermore, the incidence of stroke (3.38% vs. 6.55%, p = 0.354) and in-hospital mortality (3.23% vs. 5.58%, p = 0.454) was similar in both groups. Conclusions The research indicates that ILVA reconstruction during total aortic arch replacement via single upper right hemisternotomy effectively preserved ILVA patency and achieved excellent early outcomes. Statistically, the incidence of postoperative paraplegia was significantly lower compared to the control group, while no significant differences were observed in mortality or other complications between the two groups.