05 April 2026
: Case report 
Arch-First Technique for Extensive Thoracic Aortic Replacement: A Case Series of Patients With Complex Thoracic Aortic Disease
Management of emergency care, Rare disease, Educational Purpose (only if useful for a systematic review or synthesis)
Vlasios Karageorgos ABCDEF 1, Matias Matthew Chamogeorgakis ABEF 2, Konstantinos Ieromonachos BCDEF 2, Antigoni Koliopoulou BDEF 2, Nikolaos A. Papakonstantinou
BCDEF 2, Panagiotis Latsonas BCDEF 2, Eris Ntylgia BCDEF 2, Athanasios Katsargyris BCDEF 3, Christos Klonaris BCDEF 3, Themistoklis Chamogeorgakis ABCDEFG 2*
DOI: 10.12659/AJCR.951286
Am J Case Rep 2026; 27:e951286
Table 1 Summary of cases treated with the arch-first technique.
| Case | Age/sex | Diagnosis/indication | Comorbidities | Prior aortic/valve surgery | Marfan syndrome | Procedure performed | Major complications | Outcome/LOS (days) |
|---|---|---|---|---|---|---|---|---|
| 1 | 24/M | Arch and descending Ao aneurysm | Asthma | Bentall + MVR | Yes | Ascending, arch, and proximal descending Ao replacement | Tracheostomy, respiratory failure | Discharged, 34 days |
| 2 | 72/M | Arch aneurysm post-type A repair | Hypertension, hyperlipidemia | Ascending Ao repair | No | Ascending, arch, and proximal descending Ao replacement | Tracheostomy, respiratory failure | Discharged, 35 days |
| 3 | 73/M | Chronic dissection, contained rupture | Hypertension, hyperlipidemia, diabetes mellitus | Type A dissection repair | No | Arch and descending Ao replacement | None | Discharged, 30 days |
| 4 | 24/M | Contained rupture of descending Ao | Scoliosis | Ascending Ao repair | Yes | Ascending, arch, and proximal descending Ao replacement | Intraoperative hemorrhage | Death intraoperatively |
| 5 | 50/M | Arch and descending Ao aneurysm | Hypertension, hyperlipidemia | Bentall, MVR | Yes | Ascending, arch, and proximal descending Ao replacement | Tracheostomy, respiratory failure, prolonged ICU stay due to ventilator-associated pneumonia | Discharged, 73 days |
| 6 | 69/F | Ascending, arch, and descending Ao aneurysm | Hypertension, hyperlipidemia, diabetes mellitus | None | No | Ascending, arch, and proximal descending Ao replacement | Chylothorax, respiratory failure | Discharged, 57 days |
| Ao – aorta; F – Female; LOS – length of stay; M – Male; MVR – mitral valve replacement. | ||||||||