A 10-Year Aortic Center Experience with Hybrid Repair of Chronic “Residual” Aortic Dissection After Type A Repair



Hybrid aortic arch repair in patients with chronic residual aortic dissection (RAD) is a less invasive alternative to conventional surgical treatment. The aim of this study was to describe the short-term and long-term results of hybrid treatment for RAD after type A repair.


In this retrospective single-center cohort study, all patients treated for chronic RAD with hybrid aortic arch repair were included. Indications for treatment were rapid aortic growth, aortic diameter > 55 mm, or aortic rupture.


Between 2009 and 2020, we performed 29 hybrid treatments for chronic RAD. Twenty-four patients were treated for complete supra-aortic debranching in zones 0 and 5 with left subclavian artery debranching alone in zone 2. There was 1 perioperative death (3.4%): The patient was treated for an aortic rupture. There was no spinal cord ischemia and 1 minor stroke (3.4%). After a median follow-up of 25.4 months (range 3-97 months), the long-term mortality was 10.3% (3/29) with no late aortic-related deaths. Twenty-seven patients (93.1%) developed FL thrombosis of the descending thoracic aorta; the rate of aneurysmal progression on thoraco-abdominal aorta was 41.4% (12/29), and the rate of aortic reintervention was 34.5% (10/29).


In a high-volume aortic center, hybrid repair of RAD is associated with good anatomical results and a low risk of perioperative morbidity and mortality, including that of patients treated in zone 0. A redo replacement of the ascending aortic segment is sometimes necessary to provide a safer proximal landing zone and reduce the risk of type 1 endoleak after TEVAR.

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Availability of Data and Material

All the patients included in this study were clearly informed about the use of their data for clinical research, and the institutional review board approved the project (approval number 2019-48).

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Residual aortic dissection after type A repair


Hybrid repair


Thoracic endovascular aortic repair




Innominate artery


Left common carotid artery


Left subclavian artery


Cardiopulmonary bypass


Circulatory arrest


Antegrade cerebral protection


Computed tomography


Cerebrospinal fluid drainage


Stent-assisted balloon-induced intimal disruption and relamination in aortic dissection repair


False lumen


Near-infrared spectroscopy


Spinal cord ischemia


Confidence interval


Frozen elephant trunk


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We would like to thank Professor Michel S. Makaroun (Pittsburgh, PA) for his careful reading and comments.

Author information




All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Alizée Porto, Arnaud Blanchard, Jean Victor Chazot, Laurence Bal, Mariangela De Masi, Pierre-Antoine Barral, Alexis Jacquier, Vlad Gariboldi, Frederic Collart, Valerie Deplano, and Marine Gaudry. The first draft of the manuscript was written by Marine Gaudry, Philippe Piquet, and Alizee Porto. Axel Bartoli made all figure revisions needed to improve the manuscript. All authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Marine Gaudry.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all participants included in the study.

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The authors declare no competing interests.

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Meeting presentation: European Society of Vascular Surgery (ESVS), Hamburg, September 2019

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Gaudry, M., Porto, A., Blanchard, A. et al. A 10-Year Aortic Center Experience with Hybrid Repair of Chronic “Residual” Aortic Dissection After Type A Repair. Cardiovasc Drugs Ther (2021). https://doi.org/10.1007/s10557-021-07150-w

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  • Type A aortic dissection
  • Chronic residual type B aortic dissection
  • Hybrid repair
  • Supra-aortic debranching