Nicholas D. Andersen, Judson B. Williams, Asad A. Shah, Richard L. McCann, G. Chad Hughes
Duke University Medical Center, Durham, NC.
OBJECTIVES: To present our results with an algorithmic approach to complex “hybrid” open/endovascular aortic arch repair, based upon the extent of aortic disease and patient comorbidities.
METHODS: Between August 2005 and December 2011, 80 patients underwent hybrid arch repair by three principal procedures: zone 0 endograft coverage with aortic arch debranching (zone 0, n=45), zone 1 endograft coverage with extra-anatomic left carotid revascularization (zone 1, n=19), and stage II endovascular completion following stage I total arch repair (stented elephant trunk, n=16).
RESULTS: Median patient age was 69 years [interquartile range (IQR): 56, 74]. Sternotomy, cardiopulmonary bypass, and circulatory arrest were required in 45 (56%), 18 (23%), and 7 (9%) patients, respectively, to allow for arch debranching or concomitant aortic or cardiac procedures, including ascending+/-hemi-arch replacement in 8 (18%) patients undergoing zone 0 repair. All 16 (100%) stented elephant trunk procedures and 9 (20%) zone 0 procedures were staged, with the endovascular component performed a median of 72 days [IQR: 11, 155 days] following the open arch component. In-hospital rates of death, stroke, and permanent paraplegia/paresis were 9% (n=7), 4% (n=3), and 1% (n=1), respectively. At a mean follow-up of 27+/-21 months, 11 (14%) patients required secondary re-intervention for type 1 (n=4), type 2 (n=5), or type 3 (n=1) endoleak, or arch vessel bypass graft revision (n=1). Three (4%) patients experienced acute retrograde type A dissection following stent graft placement and 3 (4%) required late reintervention for new aortic disease. Kaplan-Meier estimates of survival at 1, 3, and 5 years were 73%, 63%, and 54%, respectively.
CONCLUSIONS: Hybrid aortic arch repair can be tailored to patient anatomy and comorbid status to allow complete repair of aortic pathology, frequently in a single stage, with acceptable outcomes.
AUTHOR DISCLOSURES: N. D. Andersen, Nothing to disclose; G. Hughes, W.L. Gore and Associates, Research Grants, W.L. Gore and Associates, Consulting fees or other remuneration (payment),W.L. Gore and Associates, Speaker’s bureau Medtronic Vascular, Consulting fees or other remuneration (payment), Medtronic Vascular, Speaker’s bureau Vascutek Terumo, Consulting fees or other remuneration (payment), Vascutek Terumo, Speaker’s bureau; R. L. McCann, Nothing to disclose; A. A. Shah, Nothing to disclose; J. B. Williams, Nothing to disclose.
Posted April 2012