Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2019 Jun;11(6):2305-2314.
doi: 10.21037/jtd.2019.06.10.

Off pump hybrid extra-anatomic techniques for aortic arch repair-own experience

Piotr Buczkowski  1 , Mateusz Puslecki  2 , Sebastian Stefaniak  1 , Robert Juszkat  3 , Jerzy Kulesza  3 , Marcin Misterski  1 , Tomasz Urbanowicz  1 , Marcin Ligowski  1 , Bartosz Zabicki  3 , Marek Dabrowski  4 , Lukasz Szarpak  5 , Damian Gorczyca  5 , Marek Jemielity  1 , Bartłomiej Perek  1
Affiliations

Off pump hybrid extra-anatomic techniques for aortic arch repair-own experience

Piotr Buczkowski et al. J Thorac Dis. 2019 Jun.

Abstract

Background: Treatment of the aortic arch pathologies is technically challenging. In this study we assess early and late outcomes of hybrid aortic arch repairs that comprise extra-anatomic surgical procedures completed by thoracic endovascular interventions [thoracic endovascular aortic repair (TEVAR)].

Methods: Since 2007, 21 patients (8 women and 13 men) with a median age of 48 years have undergone hybrid procedures for aortic arch pathologies. All of them were treated without cardio-pulmonary bypass. All survivors were followed up regularly and imaging examination were performed. A technical success, procedural complications as well as the early and late mortality and morbidity rates were evaluated.

Results: All patients survived surgery and TEVAR was technically successful in all of them. However, 2 individuals died (in-hospital mortality rate 9.5%) during in-hospital stay, both due to multi-organ failure (MOF). Additionally, one patient developed symptoms of cerebral stroke, another one of spinal cord ischemia. During the follow-up that ranged from 6 to 118 months and was completed by 100% of the survivors, one patient died 3 years after procedure because of sepsis (aorto-oesophageal fistula prior to intervention) and late vascular graft occlusions were noted in three cases.

Conclusions: Hybrid procedures on the aortic arch that comprise surgical and endovascular interventions has become an attractive and safe therapeutic option with acceptable mortality and morbidity rate. They may be considered as a method of choice in treatment of the elderly and high-risk patients.

Keywords: Aortic arch aneurysm; endovascular repair; hybrid procedures; stent graft.

PubMed Disclaimer

Conflict of interest statement

Conflicts of Interest: The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Landing Zone strategy. (A) Landing Zone concept; (B) Landing Zone 1. Hybrid TEVAR—hemi-arch debranching; (C) Landing Zone 0. Hybrid TEVAR—total-arch debranching. TEVAR, thoracic endovascular aortic repair.
Figure 2
Figure 2
3D reconstruction of CT angiography scans of hemi-arch debranching. CT, computed tomography.
Figure 3
Figure 3
Intraoperative picture of total-arch debranching. Bifurcated Dacron 16/8 mm vascular prosthesis was sewn to the ascending aorta then in end-to-end to manner to the brachiocephalic trunk and left common carotid artery.
Figure 4
Figure 4
3D reconstruction of CT angiography scans of total-arch debranching.
See this image and copyright information in PMC

References

    1. Davies RR, Goldstein LJ, Coady MA, et al. Yearly rupture or dissection rates for thoracic aortic aneurysms: simple prediction based on size. Ann Thorac Surg 2002;73:17-27. discussion 27-28. - PubMed
    1. Younes HK, Davies MG, Bismuth J, et al. Hybrid thoracic endovascular aortic repair: pushing the envelope. J Vasc Surg 2010;51:259-66. 10.1016/j.jvs.2009.09.043 - DOI - PubMed
    1. Tian DH, Wan B, Di Eusanio M, et al. A systematic review and meta-analysis on the safety and efficacy of the frozen elephant trunk technique in aortic arch surgery. Ann Cardiothorac Surg 2013;2:581-91. - PMC - PubMed
    1. Borst HG, Walterbusch G, Schaps D. Extensive aortic replacement using ‘‘elephant trunk” prosthesis. Thorac Cardiovasc Surg 1983;31:37-40. 10.1055/s-2007-1020290 - DOI - PubMed
    1. Leontyev S, Misfeld M, Daviewala P, et al. Early- and medium-term results after aortic arch replacement with frozen elephant trunk techniques-a single center study. Ann Cardiothorac Surg 2013;2:606-11. - PMC - PubMed