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

Abstract

Purpose

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.

Methods

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.

Results

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).

Conclusion

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.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2
Fig. 3
Fig. 4

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).

Code Availability

Not applicable.

Abbreviations

RAD:

Residual aortic dissection after type A repair

HR:

Hybrid repair

TEVAR:

Thoracic endovascular aortic repair

SA:

Supra-aortic

IA:

Innominate artery

LCCA:

Left common carotid artery

LSA:

Left subclavian artery

CPB:

Cardiopulmonary bypass

CA:

Circulatory arrest

ACP:

Antegrade cerebral protection

CT:

Computed tomography

CSFD:

Cerebrospinal fluid drainage

STABILISE:

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

FL:

False lumen

NIRS:

Near-infrared spectroscopy

SCI:

Spinal cord ischemia

CI:

Confidence interval

FET:

Frozen elephant trunk

References

  1. 1.

    Concistre G, Casali G, Santaniello E, et al. Reoperation after surgical correction of acute type A aortic dissection: risk factor analysis. Ann Thorac Surg. 2012;93:450–5.

    Article  Google Scholar 

  2. 2.

    Zierer A, Voeller RK, Hill KE, Kouchoukos NT, Damiano RJ Jr, Moon MR. Aortic enlargement and late reoperation after repair of acute type A aortic dissection. Ann Thorac Surg. 2007;84:479–86. discussion 486-7.

    Article  Google Scholar 

  3. 3.

    Tamura K, Chikazawa G, Hiraoka A, Totsugawa T, Sakaguchi T, Yoshitaka H. The prognostic impact of distal anastomotic new entry after acute type I aortic dissection repair. Eur J Cardiothorac Surg. 2017;52:867–73.

    Article  Google Scholar 

  4. 4.

    Fattouch K, Sampognaro R, Navarra E, Caruso M, Pisano C, Coppola G, et al. Long-term results after repair of type A acute aortic dissection according to false lumen patency. Ann Thorac Surg. 2009;88:1244–50.

    Article  Google Scholar 

  5. 5.

    Kimura N, Itoh S, Yuri K, Adachi K, Matsumoto H, Yamaguchi A, et al. Reoperation for enlargement of the distal aorta after initial surgery for acute type A aortic dissection. J Thorac Cardiovasc Surg. 2015;149:S91–8. e1.

    Article  Google Scholar 

  6. 6.

    Nakamura K, Onitsuka T, Yano M, Yano Y, Matsuyama M, Furukawa K. Risk factor analysis for ascending aorta and aortic arch repair using selective cerebral perfusion with open technique: role of open-stent graft placement. J Cardiovasc Surg. 2006;47:659–65.

    CAS  Google Scholar 

  7. 7.

    Kazui T, Yamashita K, Washiyama N, et al. Aortic arch replacement using selective cerebral perfusion. Ann Thorac Surg. 2007;83:S796–8. discussion S824-31.

    Article  Google Scholar 

  8. 8.

    Haulon S, Greenberg RK, Spear R, Eagleton M, Abraham C, Lioupis C, et al. Global experience with an inner branched arch endograft. J Thorac Cardiovasc Surg. 2014;148:1709–16.

    Article  Google Scholar 

  9. 9.

    Koullias GJ, Wheatley GH 3rd. State-of-the-art of hybrid procedures for the aortic arch: a meta-analysis. Ann Thorac Surg. 2010;90:689–97.

    Article  Google Scholar 

  10. 10.

    Cao P, De Rango P, Czerny M, et al. Systematic review of clinical outcomes in hybrid procedures for aortic arch dissections and other arch diseases. J Thorac Cardiovasc Surg. 2012;144:1286–300. 1300 e1-2.

    Article  Google Scholar 

  11. 11.

    Faure EM, El Batti S, Sutter W, et al. Stent-assisted balloon-induced intimal disruption and relamination of distal remaining aortic dissection after acute DeBakey type I repair. J Thorac Cardiovasc Surg. 2019;157:2159–65.

    Article  Google Scholar 

  12. 12.

    Faure EM, El Batti S, Sutter W, et al. Stent-assisted balloon dilatation of chronic aortic dissection. J Thorac Cardiovasc Surg. 2020;S0022–5223(20)30430–X. Online ahead of print.

  13. 13.

    Czerny M, Kreibich M, Morlock J, Kondov S, Scheumann J, Schröfel H, et al. Chronic type B “residual” after type A: what I would do? J Vis Surg. 2018;4:14.

    Article  Google Scholar 

  14. 14.

    Dell’Aquila AM, Pollari F, Fattouch K, Santarpino G, Hillebrand J, Schneider S, et al. Early outcomes in re-do operation after acute type A aortic dissection: results from the multicenter REAAD database. Heart Vessel. 2017;32:566–73.

    Article  Google Scholar 

  15. 15.

    Malvindi PG, van Putte BP, Sonker U, Heijmen RH, Schepens MA, Morshuis WJ. Reoperation after acute type A aortic dissection repair: a series of 104 patients. Ann Thorac Surg. 2013;95:922–7.

    Article  Google Scholar 

  16. 16.

    Quintana E, Bajona P, Schaff HV, Dearani JA, Daly RC, Greason KL, et al. Open aortic arch reconstruction after previous cardiac surgery: outcomes of 168 consecutive operations. J Thorac Cardiovasc Surg. 2014;148:2944–50.

    Article  Google Scholar 

  17. 17.

    Di Bartolomeo R, Berretta P, Pantaleo A, et al. Long-term outcomes of open arch repair after a prior aortic operation: our experience in 154 patients. Ann Thorac Surg. 2017;103:1406–12.

  18. 18.

    Verscheure D, Haulon S, Tsilimparis N, Resch T, Wanhainen A, Mani K, et al. Endovascular treatment of post type A chronic aortic arch dissection with a branched endograft: early results from a retrospective international multicenter study. Ann Surg. 2019; Online ahead of print.

  19. 19.

    Papakonstantinou NA, Antonopoulos CN, Baikoussis NG, Kakisis I, Geroulakos G. Aortic arch reconstruction: are hybrid debranching procedures a good choice? Heart Lung Circ. 2018;27:1335–49.

    Article  Google Scholar 

  20. 20.

    Shirakawa Y, Kuratani T, Shimamura K, Torikai K, Sakamoto T, Shijo T, et al. The efficacy and short-term results of hybrid thoracic endovascular repair into the ascending aorta for aortic arch pathologies. Eur J Cardiothorac Surg. 2014;45:298–304. discussion 304.

    Article  Google Scholar 

  21. 21.

    Antoniou GA, El Sakka K, Hamady M, Wolfe JH. Hybrid treatment of complex aortic arch disease with supra-aortic debranching and endovascular stent graft repair. Eur J Vasc Endovasc Surg. 2010;39:683–90.

    CAS  Article  Google Scholar 

  22. 22.

    Canaud L, Gandet T, Ozdemir BA, Albat B, Marty-Ane C, Alric P. Hybrid aortic repair of dissecting aortic arch aneurysm after surgical treatment of acute type A dissection. Ann Vasc Surg. 2016;30:175–80.

    Article  Google Scholar 

  23. 23.

    Antoniou GA, Mireskandari M, Bicknell CD, Cheshire NJW, Gibbs RG, Hamady M, et al. Hybrid repair of the aortic arch in patients with extensive aortic disease. Eur J Vasc Endovasc Surg. 2010;40:715–21.

    CAS  Article  Google Scholar 

  24. 24.

    Vallejo N, Rodriguez-Lopez JA, Heidari P, Wheatley G, Caparrelli D, Ramaiah V, et al. Hybrid repair of thoracic aortic lesions for zone 0 and 1 in high-risk patients. J Vasc Surg. 2012;55:318–25.

    Article  Google Scholar 

  25. 25.

    Conzelmann LO, Hoffmann I, Blettner M, Kallenbach K, Karck M, Dapunt O, et al. Analysis of risk factors for neurological dysfunction in patients with acute aortic dissection type A: data from the German Registry for Acute Aortic Dissection type A (GERAADA). Eur J Cardiothorac Surg. 2012;42:557–65.

    Article  Google Scholar 

  26. 26.

    Faure EM, El Batti S, Abou Rjeili M, Julia P, Alsac JM. Mid-term outcomes of stent assisted balloon induced intimal disruption and relamination in aortic dissection repair (STABILISE) in acute type B aortic dissection. Eur J Vasc Endovasc Surg. 2018;56:209–15.

    Article  Google Scholar 

  27. 27.

    Sayer D, Bratby M, Brooks M, Loftus I, Morgan R, Thompson M. Aortic morphology following endovascular repair of acute and chronic type B aortic dissection: implications for management. Eur J Vasc Endovasc Surg. 2008;36(5):522–9.

    CAS  Article  Google Scholar 

  28. 28.

    Canaud L, Gandet T, Sfeir J, Ozdemir BA, Solovei L, Alric P. Risk factors for distal stent graft-induced new entry tear after endovascular repair of thoracic aortic dissection. J Vasc Surg. 2019;69(5):1610–4.

    Article  Google Scholar 

Download references

Acknowledgements

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

Author information

Affiliations

Authors

Contributions

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.

Ethics declarations

Ethical Approval

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.

Informed Consent

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

Conflict of Interest

The authors declare no competing interests.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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

Supplementary Information

ESM 1

(XLSX 112 kb)

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

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

Download citation

Keywords

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