Single-stage transmedial approach to a Stanford type B dissection in a patient with Marfan's syndrome.

We report the case of a patient with Marfan's syndrome and a Stanford type B chronic aortic dissection in which replacement of the ascending aorta, aortic arch and descending aorta was accomplished in a single stage via median sternotomy. The patient was a 51-year-old woman with a 70 mm Stanford type B chronic aortic dissection and Marfan's syndrome. Median sternotomy and replacement of the ascending aorta, aortic arch, and descending aorta were performed under deep hypothermic circulatory arrest. Postoperatively, the patient developed paraplegia. However, after immediate placement of an intrathecal catheter and drainage of cerebrospinal fluid for 72 hours, the neurologic deficit fully resolved. Despite concerns related to the complexity of the procedure and neurological protection during the procedure, we believe that single-stage replacement of the ascending aorta, aortic arch, and descending aorta is possible and is one of several surgical choices for patients such as ours.