Long-term outcomes after the mesenteric artery growth improves circulation (MAGIC) procedure for midaortic syndrome.

Abstract

Midaortic syndrome is characterized by narrowing of the thoracic/abdominal aorta with visceral and renal vasculature involvement. The procedure "mesenteric artery growth improves circulation" is a novel surgical technique using the meandering mesenteric artery as an aorto-aortic bypass, avoiding potential prosthetic graft-associated complications seen in the traditional surgical management of midaortic syndrome. We conducted a single-center retrospective review of patients who underwent the mesenteric artery growth improves circulation procedure at our institution from 2012 to 2023. Data on patient preoperative, intraoperative, and postoperative details were collected and analyzed. A longitudinal analysis was performed using generalized estimation equations modeling to examine overall meandering mesenteric artery graft growth trends. Nineteen patients underwent the mesenteric artery growth improves circulation procedure during our study period, with a median follow-up of 2.28 years (range, 0.04-10.9 years). The median age at surgery was 12.0 years (range, 0.85-17.7 years). Postoperatively, patients used significantly fewer antihypertensive medications (1.3 ± 1.2 at last follow-up vs 2.6 ± 1.5 preoperatively, P = .006) and had a significant decrease in hypertension staging (P = .010) without any mortality in our cohort. Long-term, meandering mesenteric artery graft diameter increased by 0.80 mm per year postoperatively (slope = 0.80 per year; 95% confidence interval, 0.62-0.98; P < .001). Patients who underwent the mesenteric artery growth improves circulation procedure required a significantly fewer number of antihypertensives and had improvement in their blood pressure after surgery. Notably, the meandering mesenteric artery grafts continued to show significant growth over time, supporting the use of native vessels for aortic reconstruction in patients with meandering mesenteric artery.