Clinical outcomes in hybrid repair procedures for pathologies involving the aortic arch

• Published in: Vascular Vol. 23; no. 1; p. 9
• Main Authors: Zerwes, Sebastian, Leissner, Giesbert, Gosslau, Yvonne, Jakob, Rudolf, Bruijnen, Hans-Kees, Oertl, Frank, Woelfle, Klaus
• Format: Journal Article
• Language: English
• Published: England 01.02.2015
• Subjects: Aged; Aorta, Thoracic - diagnostic imaging; Aorta, Thoracic - surgery; Aortic Diseases - diagnosis; Aortic Diseases - mortality; Aortic Diseases - surgery; Aortography - methods; Blood Vessel Prosthesis; Blood Vessel Prosthesis Implantation - adverse effects; Blood Vessel Prosthesis Implantation - instrumentation; Blood Vessel Prosthesis Implantation - mortality; Cardiopulmonary Bypass; Circulatory Arrest, Deep Hypothermia Induced; Elective Surgical Procedures; Emergencies; Endoleak - etiology; Endovascular Procedures - adverse effects; Endovascular Procedures - instrumentation; Endovascular Procedures - mortality; Female; Germany; Humans; Kaplan-Meier Estimate; Male; Prosthesis Design; Retrospective Studies; Risk Factors; Stents; Sternotomy; Stroke - etiology; Time Factors; Tomography, X-Ray Computed; Treatment Outcome; debranching; aortic arch; Hybrid repair; aortic dissection; stroke; clinical results
• ISSN: 1708-5381
• DOI: 10.1177/1708538114525608

Fifty patients with complex aortic disease, who received hybrid treatment of the aortic arch with supra-aortic debranching and endovascular stent-graft repair, were evaluated in regard to events of primary (survival and technical success) and secondary (procedure-related complications) interest. The single-center study was conducted over an eight-year period from December 2004 to December 2012. Treated medical conditions included 23 aortic aneurysms (46%), 21 aortic dissections (42%), and six penetrating aortic ulcers (12%). Procedures were divided into groups of elective, urgent, and emergent. Twenty-eight (56%) patients were operated electively, 15 (30%) urgently, and seven (14%) emergently. Sternotomy, cardiopulmonary bypass, and deep hypothermic circulatory arrest were required in 12 (24%) patients. The primary technical success rate was 86% and raised to 92% (n=46) of secondary technical success rate after therapy of three type I endoleaks. The 30-day mortality added up to 16.0%, and the mean time of survival was 49.3 months. In a total of eight (16%) patients, an endoleak occurred (five endoleaks type I, three endoleaks type II), while nine (18%) of patients suffered a perioperative stroke. In severely ill patients with complex aortic diseases, hybrid therapy may offer a promising alternative to conventional open repair.