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. 2013 May;2(3):280-7.
doi: 10.3978/j.issn.2225-319X.2013.05.09.

Type I and Type II hybrid aortic arch replacement: postoperative and mid-term outcome analysis

Prashanth Vallabhajosyula  1 , Wilson Szeto, Nimesh Desai, Joseph E Bavaria
Affiliations

Type I and Type II hybrid aortic arch replacement: postoperative and mid-term outcome analysis

Prashanth Vallabhajosyula et al. Ann Cardiothorac Surg. 2013 May.

Abstract

Background: Hybrid aortic arch replacement has emerged as a safe treatment modality for arch aneurysms, especially in patients of old age and with greater comorbid burden. We assessed our institutional outcomes in patients undergoing Types I and II hybrid aortic arch replacement.

Methods: From 2005 to 2012, 685 patients underwent thoracic endovascular repair (TEVAR), of whom 104 had hybrid arch repair (open + endovascular approach). 47 of these patients had treatment for aortic arch aneurysm ± proximal ascending aortic aneurysm. The hybrid repair entailed aortic arch vessel debranching and concomitant/delayed antegrade ± retrograde TEVAR stent grafting of the arch. Type III patients were excluded from the analysis. Data was prospectively maintained.

Results: 28 patients had Type I repair, 8 had Type II repair, and 11 had Type III repair. Mean age was 71±8 years. Primary aortic pathology was aneurysm (81%), followed by chronic arch dissection (11%). 14% of patients required reoperative cardiac surgery. Stent graft deployment rate was 100% after arch vessel debranching. Postoperative endoleak rate was zero. Average cardiopulmonary bypass time was 215±64 minutes, with crossclamp time of 70±55 minutes, and circulatory arrest time of 50±17 minutes. Paraplegia rate was 5.5% (n=2), with stroke rate of 8% (n=3) and renal failure rate of 3% (n=1) requiring hemodialysis. In-hospital mortality was 8% (n=3). Mean length of stay was 17.2±14 days. Median follow-up was 30±21 months. Freedom from all-cause mortality was 71%, 60%, and 48% at 1, 3, and 5 years respectively. Aortic reoperation rate was 2.7% (n=1). No patient had Type I or III endoleak at follow-up. Freedom from mortality was improved in cases performed more recently (July 2008 to 2012) than during our early experience (2005 to June 2008) (81% versus 44% at 3 years, P=0.05).

Conclusions: Hybrid aortic arch replacement can be performed with good postoperative and midterm results in a cohort of old patients with significant comorbidity. With greater experience, early and midterm outcomes continue to improve. The hybrid arch technique may represent a technical advancement in the field of aortic arch surgery.

Keywords: Hybrid aortic arch replacement; midterm outcome; postoperative outcome; thoracic endovascular repair (TEVAR).

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Figures

Figure 1
Figure 1
Hybrid aortic arch repair Types I, II and III
Figure 2
Figure 2
Midterm follow-up survival curves for Type I and Type II hybrids are shown. Mean follow-up was 30±21 months. Late stroke and endoleak rate was 0%. Aortic reoperation rate was 2.7%. A. Overall survival in Types I and II arch hybrid repairs; B. Survival curves for Type I versus Type II arch hybrid repair; C. Overall survival for Types I and II arch hybrid procedures performed during our early experience (2005 to June 2008) compared to our late experience (July 2008 to 2012)
See this image and copyright information in PMC

References

    1. Svensson LG, Kim KH, Blackstone EH, et al. Elephant trunk procedure: newer indications and uses. Ann Thorac Surg 2004;78:109-16; discussion 109-16 - PubMed
    1. Svensson LG, Crawford ES, Hess KR, et al. Deep hypothermia with circulatory arrest. Determinants of stroke and early mortality in 656 patients. J Thorac Cardiovasc Surg 1993;106:19-28; discussion 28-31 - PubMed
    1. Sundt TM, 3rd, Orszulak TA, Cook DJ, et al. Improving results of open arch replacement. Ann Thorac Surg 2008;86:787-96; discussion 787-96 - PubMed
    1. Zeeshan A, Woo EY, Bavaria JE, et al. Thoracic endovascular aortic repair for acute complicated type B aortic dissection: superiority relative to conventional open surgical and medical therapy. J Thorac Cardiovasc Surg 2010;140:S109-15; discussion S142-S146. - PubMed
    1. Frigiola A, Ranucci M, Carlucci C, et al. The Ross procedure in adults: long-term follow-up and echocardiographic changes leading to pulmonary autograft reoperation. Ann Thorac Surg 2008;86:482-9 - PubMed