TABLE 1.

History of cardiovascular interventions

	Patient 1 (MFS)	Patient 2
First presentation	2000: Presented to an outside hospital with an acute type A dissection. Underwent Bentall procedure with St Jude mechanical composite valve graft and CABG.	October 2013: Presented to the same outside hospital with an acute type B aortic dissection extending from the left subclavian artery to the aortic bifurcation. Treated medically.
B-SAFER operation	February 2018: Presented to the same hospital with an acute on chronic type B dissection and dTAA measuring 5.9 cm. Underwent B-SAFER procedure with: • Right vertebral-to-carotid artery transposition by vascular surgery • Redo ascending and zone 2 aortic arch replacement • FET (C-TAG 37 mm × 10 cm) placed at zone 2 aortic arch over a guidewire placed through femoral artery • 13-mm × 2.5-cm and 6-mm × 5-cm VIABAHN stent graft placement in the left subclavian and left vertebral arteries • Reimplantation of the left common carotid and innominate arteries March 2018: Underwent completion TEVAR (C-TAG 37 mm × 20 cm) of the descending aorta to the level of the celiac artery with balloon rupture of dissection flap distally and placement of 13-mm × 2.5-cm VIABAHN stent graft in the LScA (Figure 1)	November 2018: Presented to the same hospital with chronic type B dissection and TAAA measuring 5.2 cm. Underwent B-SAFER procedure with: • Ascending aorta and hemiarch replacement • FET (C-TAG 37 mm × 15 cm) placed from zone 2 aortic arch without guidewire • 13 mm × 2.5-cm VIABAHN stent graft placement in the left subclavian artery (Figure 3, C)
Open reoperation	April 2019: Transferred to our facility with back pain and a rapidly expanding dTAA measuring 7.5 cm. Underwent urgent left-sided thoracotomy with: • Left subclavian and femoral artery cannulation • Aortic arch and descending thoracic aorta replacement under HCA at 18°C (bladder) from zone 2 arch to celiac artery with antegrade cerebral perfusion through LScA • T11 intercostal artery reimplantation • Cryoablation of T3-T9 intercostal nerves	March 2019: Transferred to our facility with an expanding TAAA measuring 6.5 cm. Required pulmonary rehabilitation before surgery. September 2019: Underwent a left-sided thoracoabdominal incision with: • Left subclavian and femoral artery cannulation • Aortic arch and thoracoabdominal aortic replacement under HCA from zone 3 arch to superior mesenteric artery with antegrade cerebral perfusion through LScA • Celiac artery reimplantation • T11 intercostal artery reimplantation • Cryoablation of T3-T9 intercostal nerves

MFS, Marfan syndrome; CABG, coronary artery bypass graft; B-SAFER, branched single anastomosis frozen elephant trunk repair; dTAA, descending thoracic aortic aneurysm; FET, frozen elephant trunk; TEVAR, thoracic endovascular aortic repair; LScA, left subclavian artery; TAAA, thoracoabdominal aortic aneurysm; HCA, hypothermic circulatory arrest.