A Case Series of a Hybrid Approach to Aortic Arch Disease
DOI:
https://doi.org/10.1532/HSF98.20131022Abstract
Objective: Debranching of the aortic arch and endovascular stent placement as a combination therapy for complex aortic arch pathology has emerged over the past few years as an alternative to traditional repair. This hybrid approach is a viable option for patients who would not tolerate conventional arch replacement, as well as for patients with a failed stent graft of the descending aorta and a subsequent type I endoleak.
Methods: We retrospectively reviewed the preoperative characteristics and postoperative outcomes of 5 patients who underwent debranching of the aortic arch and implantation of an endovascular stent across the aortic arch between 2008 and 2011. Data were analyzed with the Student t test and the Kaplan-Meyer method.
Results: The mean age was 70.6 ± 18 years; 4 men and 1 woman were evaluated. One patient had previous aortic surgery for dissection. The preoperative morbidities included arrhythmia (1 patient), chronic obstructive pulmonary disease (2 patients), cerebrovascular accident (1 patient), diabetes mellitus (2 patients), coronary artery disease (2 patients), and active angina (1 patient). One patient had a myocardial infarction 3 weeks before surgery. The primary technical-success rate was 100%, and none of the patients died in the perioperative phase. The mean follow-up time was 22 ± 18.4 months, and the median follow-up time was 13.8 months (range, 7.13-50.7 months). Two patients died during follow-up. The pathology of the aorta in the patients who died was arch aneurysm; the 3 remaining patients are alive and regularly followed at our institution.
Conclusion: The combination of surgery and simultaneous endovascular stenting in the operating room is an alternative approach for patients who are poor candidates for traditional arch repair under circulatory arrest.
References
Bavaria J, Milewski RK, Baker J, Moeller P, Szeto W, Pochettino A. 2010. Classic hybrid evolving approach to distal arch aneurysms: toward the zone zero solution. J Thorac Cardiovasc Surg 140(suppl):S77-80; discussion S86-91.nBavaria J, Vallabhajosyula P, Moeller P, Szeto W, Desai N, Pochettino A. 2013. Hybrid approaches in the treatment of aortic arch aneurysms: postoperative and midterm outcomes. J Thorac Cardiovasc Surg 145(suppl):S85-90.nBrueck M, Heidt MC, Szente-Varga M, Bandorski D, Kramer W, Vogt PR. 2006. Hybrid treatment for complex aortic problems combining surgery and stenting in the integrated operating theater. J Interv Cardiol 19:539-43.nCires G, Noll RE Jr, Albuquerque FC Jr, Tonnessen BH, Sternbergh WC 3rd. 2011. Endovascular debranching of the aortic arch during thoracic endograft repair. J Vasc Surg 53:1485-91.nCzerny M, Zimpfer D, Fleck T, et al. 2004. Initial results after combined repair of aortic arch aneurysms by sequential transposition of the supra-aortic branches and consecutive endovascular stent-graft placement. Ann Thorac Surg 78:1256-60.nFerrero E, Ferri M, Viazzo A, et al. 2012. Is total debranching a safe procedure for extensive aortic-arch disease? A single experience of 27 cases. Eur J Cardiothorac Surg 41:177-82.nGottardi R, Funovics M, Eggers N, et al. 2008. Supra-aortic transposition for combined vascular and endovascular repair of aortic arch pathology. Ann Thorac Surg 86:1524-9.nKoullias GJ, Wheatley GH 3rd. 2010. State-of-the-art of hybrid procedures for the aortic arch: a meta-analysis. Ann Thorac Surg 90:689-97.nNeragi-Miandoab S, Tuchak J, Bakhos M, Schwartz JP. 2006. Open repair of a new aneurysm of the thoracoabdominal aorta after endovascular stent placement. J Thorac Cardiovasc Surg 132:157-8.nRiambau V, Zipfel B, Coppi G, et al. 2011. Final operative and midterm results of the European experience in the RELAY Endovascular Registry for Thoracic Disease (RESTORE) study. J Vasc Surg 53:565-73.nSchwartz JP, Bakhos M, Patel A, Botkin S, Neragi-Miandoab S. 2008. Repair of aortic arch and the impact of cross-clamping time, New York Heart Association stage, circulatory arrest time, and age on operative outcome. Interact Cardiovasc Thorac Surg 7:425-9.nTiesenhausen K, Hausegger KA, Oberwalder P, et al. 2003. Left subclavian artery management in endovascular repair of thoracic aortic aneurysms and aortic dissections. J Card Surg 18:429-35.nTorsello GB, Torsello GF, Osada N, Teebken OE, Ratusinski CM, Nienaber CA. 2010. Midterm results from the TRAVIATA registry: Treatment of Thoracic Aortic Disease with the Valiant Stent Graft. J Endovasc Ther 17:137-50.nVallejo N, Rodriguez-Lopez JA, Heidari P, et al. 2012. Hybrid repair of thoracic aortic lesions for zone 0 and 1 in high-risk patients. J Vasc Surg 55:318-25.nYilik L, Gokalp O, Yurekli I, et al. 2012. Hybrid repair of aortic arch aneurysms in same session. Thorac Cardiovasc Surg 60:501-7.nYounes HK, Davies MG, Bismuth J, et al. 2010. Hybrid thoracic endovascular aortic repair: pushing the envelope. J Vasc Surgery 51:259-66.n
