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Long-Term Outcomes of the Mesenteric Artery Growth Improves Circulation (MAGIC) Procedure for Midaortic Syndrome
Megan Z. Chiu
1, Donna C. Koo
1, Steven J. Staffa
1, Diego Porras
2, Gulraiz Chaudry
3, Deborah R. Stein
4, Michael A. Ferguson
4, Michelle Dowling
1, Alex G. Cuenca
1, Heung Bae Kim
1, Eliza J. Lee
1
1Department of Surgery, Boston Children’s Hospital, Boston, MA; 2Department of Cardiology, Boston Children’s Hospital, Boston, MA; 3Department of Radiology, Boston Children’s Hospital, Boston, MA; 4Department of Nephrology, Boston Children’s Hospital, Boston, MA
Background: The Mesenteric Artery Growth Improves Circulation (MAGIC) procedure is a novel surgical technique using the meandering mesenteric artery (MMA) for aorto-aortic bypass, avoiding potential prosthetic graft-associated complications in traditional surgical management of Midaortic Syndrome (MAS), characterized by narrowing of the thoracic/abdominal aorta with visceral and renal vasculature involvement.
Methods: We conducted a single-center retrospective review of patients who underwent a MAGIC procedure at our institution from 2010-2023. Data on patient preoperative, intraoperative, and postoperative details were collected and analyzed.
Results: Eighteen patients underwent the MAGIC procedure during our study period with a median follow-up of 3.41 years (range: 0.58-10.9). The median age at surgery was 12.2 years (range: 0.85-17.7). Postoperatively, patients utilized significantly fewer antihypertensives after surgery (1.30±1.38 at last follow-up vs. 2.69±1.60 preoperatively, (P=0.015) and had a trend toward decreased hypertension staging after surgery without any mortality in our cohort. Long-term, MMA graft diameter increased by 0.80 mm per year postoperatively (slope = 0.80 per year; 95% CI: 0.62, 0.98; P<0.001) (Figure 1).
Conclusions: MAGIC patients required a significantly lower number of antihypertensives and had improvement in their blood pressure after surgery. Notably, the MMA grafts continued to show significant growth over time, supporting the use of native vessels for aortic reconstruction in MAS patients.
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