Postoperative Outcomes of Hybrid Repair in the Treatment of Aortic Arch Aneurysms

• Published in: Annals of vascular surgery Vol. 34; pp. 55 - 61
• Main Authors: Narita, Hiroshi, Komori, Kimihiro, Usui, Akihiko, Yamamoto, Kiyohito, Banno, Hiroshi, Kodama, Akio, Sugimoto, Masayuki
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Inc 01.07.2016
• Subjects: Adult; Aged; Aged, 80 and over; Aortic Aneurysm, Thoracic - diagnostic imaging; Aortic Aneurysm, Thoracic - mortality; Aortic Aneurysm, Thoracic - surgery; Blood Vessel Prosthesis Implantation - adverse effects; Blood Vessel Prosthesis Implantation - mortality; Databases, Factual; Elective Surgical Procedures; Endoleak - etiology; Endoleak - therapy; Endovascular Procedures - adverse effects; Endovascular Procedures - mortality; Female; Hospital Mortality; Humans; Male; Middle Aged; Paraplegia - etiology; Retreatment; Retrospective Studies; Risk Factors; Stroke - etiology; Surgery; Time Factors; Treatment Outcome
• ISSN: 0890-5096; 1615-5947
• DOI: 10.1016/j.avsg.2015.11.041

Background The advent of thoracic endovascular aneurysm repair (TEVAR) has bought about a tremendous revolution in the treatment strategy for aortic arch aneurysms. We reviewed our experience using TEVAR with the hybrid approach in the treatment of aortic arch aneurysms to evaluate its feasibility, safety, and effectiveness. Methods Between October 2008 and July 2014, 61 consecutive patients (51 men; mean age 75.8 ± 7.7 years; range, 43–85 years) underwent elective treatment for aortic arch aneurysms with the hybrid approach. The 61 patients were separated into 2 groups. Thirty-five patients underwent total debranching TEVAR for zone 0 (debranching TEVAR group), 26 patients underwent long elephant trunk (ET) followed by secondary retrograde TEVAR (ET group). Preoperative, perioperative, and follow-up data were collected retrospectively in the database. Results The technical success rate was 100%. The paraplegia rates in total debranching TEVAR and long ET TEVAR and were 2.9% and 3.8%, respectively. The stroke rates in total debranching TEVAR and long ET TEVAR were 11.4% and 7.7%, respectively. The overall 30-day mortality and in-hospital mortality rates for all 61 patients were 0% and 3.4% ( n  = 2; both were in the total debranching TEVAR group), respectively. There were no perioperative type 1 or 3 endoleaks that required secondary intervention. The mean hospital stay was 15.8 days. The median follow-up was 309 ± 303 days. No aneurysm-related deaths occurred during follow-up. Conclusions The hybrid approach can be safely performed with good technical success and good midterm results. In future, new alternative devices for aortic arch pathologies, such as a branched stent graft that eliminates extra-anatomic bypass, should be developed.