Debranching Thoracic Endovascular Aortic Repair Combined with Ascending Aortic Banding: Analysis of a New Surgical Procedure

Authors

  • Hui-Qiang Gao Department of Cardiac Surgery, Beijing Anzhen Hospital, Beijing Institute of Heart, Lung & Vascular Diseases, Capital Medical University, 100029 Beijing, China
  • Shang-Dong Xu Department of Cardiac Surgery, Beijing Anzhen Hospital, Beijing Institute of Heart, Lung & Vascular Diseases, Capital Medical University, 100029 Beijing, China
  • Jun Zheng Department of Cardiac Surgery, Beijing Anzhen Hospital, Beijing Institute of Heart, Lung & Vascular Diseases, Capital Medical University, 100029 Beijing, China

DOI:

https://doi.org/10.1532/hsf.5389

Keywords:

banding, debranch, thoracic endovascular aortic repair, retrograde type A aortic dissection

Abstract

Background: To analyze the clinical effect of debranching thoracic endovascular aortic repair combined with ascending aortic banding. Methods: The clinical data of patients who underwent a debranching thoracic endovascular aortic repair combined with ascending aortic banding at Anzhen Hospital (Beijing, China) between January 2019 and December 2021 were reviewed to evaluate the occurrence and outcomes of postoperative complications. Results: A total of 30 patients underwent a debranching thoracic endovascular aortic repair combined with ascending aortic banding. There were 28 male patients (93.3%) with an average age of 59.9 ± 11.8 years. Twenty-five patients underwent simultaneous surgery and five patients had staged surgery. Postoperatively, two patients developed complete paraplegia (6.7%), three patients developed incomplete paraplegia (10%), two patients developed cerebral infarction (6.7%), and one patient developed femoral artery thromboembolism (3.3%). No patient died during the perioperative period, and one patient (3.3%) died during the follow-up period. None of the patients underwent retrograde type A aortic dissection during the perioperative and postoperative follow-up periods. Conclusions: Banding the ascending aorta with a vascular graft to restrict its movement and to serve as the proximal anchoring area of the stent graft can reduce the risk of retrograde type A aortic dissection.

References

Geisbüsch P, Kotelis D, Müller-Eschner M, Hyhlik-Dürr A, Böckler D. Complications after aortic arch hybrid repair. Journal of Vascular Surgery. 2011; 53: 935–941.

Tokuda Y, Oshima H, Narita Y, Abe T, Araki Y, Mutsuga M, et al. Hybrid versus open repair of aortic arch aneurysms: comparison of postoperative and mid-term outcomes with a propensity score-matching analysis. European Journal of Cardio-Thoracic Surgery. 2016; 49: 149–156.

Zheng J, Li JR, Xu SD, Gao HQ. Debranching thoracic endovascular aortic repair combined with ascending aortic aortoplasty. Chinese Medical Journal. 2019; 132: 2242–2243.

Dueppers P, Reutersberg B, Rancic Z, Messmer F, Menges AL, Meuli L, et al. Long-term results of total endovascular repair of arch-involving aortic pathologies using parallel grafts for supra-aortic debranching. Journal of Vascular Surgery. 2022; 75: 813–823.e1.

Moulakakis KG, Mylonas SN, Markatis F, Kotsis T, Kakisis J, Liapis CD. A systematic review and meta-analysis of hybrid aortic arch replacement. Annals of Cardiothoracic Surgery. 2013; 2: 247–260.

Yoshizumi T, Tokuda Y, Abe T, Usui A. Conservative treatment of type A aortic dissection following hybrid arch repair. General Thoracic and Cardiovascular Surgery. 2019; 67: 602–607.

Gandet T, Canaud L, Ozdemir BA, Ziza V, Demaria R, Albat B, et al. Factors favoring retrograde aortic dissection after endovascular aortic arch repair. The Journal of Thoracic and Cardiovascular Surgery. 2015; 150: 136–142.

Bavaria J, Vallabhajosyula P, Moeller P, Szeto W, Desai N, Pochettino A. Hybrid approaches in the treatment of aortic arch aneurysms: postoperative and midterm outcomes. The Journal of Thoracic and Cardiovascular Surgery. 2013; 145: S85–S90.

Joo HC, Youn YN, Kwon JH, Won JY, Lee DY, Ko YG, et al. Late complications after hybrid aortic arch repair. Journal of Vascular Surgery. 2019; 70: 1023–1030.e1.

Yip HC, Chan YC, Qing KX, Cheng SW. Retrograde type A dissection following hybrid supra-aortic endovascular surgery in high-risk patients unfit for conventional open repair. The Journal of Cardiovascular Surgery. 2018; 59: 243–251.

Czerny M, Weigang E, Sodeck G, Schmidli J, Antona C, Gelpi G, et al. Targeting landing zone 0 by total arch rerouting and TEVAR: midterm results of a transcontinental registry. The Annals of Thoracic Surgery. 2012; 94: 84–89.

Tshomba Y, Bertoglio L, Marone EM, Logaldo D, Maisano F, Chiesa R. Retrograde type A dissection after endovascular repair of a “zone 0” nondissecting aortic arch aneurysm. Annals of Vascular Surgery. 2010; 24: 952.e1–952.e7.

Jin S, Oshinski J, Giddens DP. Effects of wall motion and compliance on flow patterns in the ascending aorta. Journal of Biomechanical Engineering. 2003; 125: 347–354.

Published

2023-06-25

How to Cite

Gao, H.-Q., Xu, S.-D., & Zheng, J. (2023). Debranching Thoracic Endovascular Aortic Repair Combined with Ascending Aortic Banding: Analysis of a New Surgical Procedure. The Heart Surgery Forum, 26(3), E271-E276. https://doi.org/10.1532/hsf.5389

Issue

Section

Article