Abstract
Purpose
Hybrid aortic arch replacement (HAAR) is emerging as a safe treatment alternative for aortic arch pathologies. HAAR is divided into three groups. We have assessed our outcome for all three types of HAAR.
Method
From January 2007 to December 2016, we have performed 119 endovascular aortic repair (EVAR) of the aorta of which 56 were hybrid aortic arch repair. The hybrid repair entailed aortic arch vessel debranching and concomitant/delayed antegrade ± retrograde EVAR stent grafting of the arch. For group I and II hybrid patients, we debranch the supra-aortic arch vessels without the aid of circulatory arrest. EVAR was performed on the following day. In group III, hybrid antegrade EVAR of the thoracic aorta and arch reconstruction was performed in single stage.
Results
Of the 56 patients, 16 were in group I, 32 in group II, and 8 in group III. Mean age was 59.9 ± 9.4 years with 78.57% (n = 44) being males. Aortic dissection was the primary pathology in 31 (55.36%) patients followed by aneurysm in 24 (42.86%) patients. Marfans syndrome was present in 28.57% (n = 16) patients. Redosternotomy was performed in 10.71% patients (n = 6). Incidence of stroke was 5.38% (n = 3) and there was no patients with renal dysfunction requiring hemodialysis. There were two retrograde aortic dissections and two endoleaks, both in group I patients. Thirty days in-hospital mortality was 5.38% (2 in group I and 1 in group II).
Conclusion
Hybrid aortic arch replacement can be performed with good postoperative outcome. Type II hybrid is better than type I hybrid in our experience. As experience increases, the outcome continues to improve.
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References
Kim T, Martin TD, Lee WA, et al. Evolution in the management of the total thoracic aorta. J Thorac Cardiovasc Surg. 2009;137:627–34.
Milewski RK, Szeto WY, Pochettino A, Moser GW, Moeller P, Bavaria JE. Have hybrid procedures replaced open aortic arch reconstruction inhigh-risk patients? A comparative study of elective open arch debranching with endovascular stent graft placement and conventional elective open total and distal aortic arch reconstruction. J Thorac Cardiovasc Surg. 2010;140:590–7.
Hughes GC, Daneshmand MA, Swaminathan M, et al. "Real world" thoracic endografting: results with the Gore TAG device 2 years after U.S. FDA approval. Ann Thorac Surg.2008;86: 1530–1538.
Clough RE, Modarai B, Topple JA, et al. Predictors of stroke and paraplegia in thoracic aortic endovascular intervention. Eur J Vasc Endovasc Surg. 2011;41:303–10.
Therneau T (2015). A Package for Survival Analysis in S.r package version 2.38, <https://CRAN.Rproject.org/package=survival>).
Matalanis G, Durairaj M, Brooks M. A hybrid technique of aortic arch branch transposition and antegrade stent graft deployment for complete arch repair without cardiopulmonary bypass. Eur J Cardiothorac Surg. 2006;29: 611–2.
Kpodonu J, Diethrich EB. Hybrid interventions for the treatment of the complex aortic arch. Perspect Vasc Surg EndovascTher. 2007;19:174–84.
Shin JH, Yoon HK, Chung CH, et al. Hybrid procedure with antegrade stentgraft placement for aortic arch aneurysms: preliminary experience in eight patients. J Vasc Interv Radiol. 2011;22: 148–54.
Lee CW, Beaver TM, Klodell CT Jr, et al. Arch debranching versus elephant trunk procedures for hybrid repair of thoracic aortic pathologies. Ann Thorac Surg. 2011;91:465–71.
Cao P, De Rango P, Czerny M, et al. Systematic review of clinical outcomes in hybrid procedures for aortic archdissections and other arch diseases. J Thorac Cardiovasc Surg. 2012;144:1286–300.
Appoo JJ, Pozeg Z. Strategies in the surgical treatment of type A aortic arch dissectionAnn Cardiothorac Surg.2013;2:205–211.
Kotelis D, Geisbüsch P, Attigah N, Hinz U, Hyhlik-Dürr A, Böckler D. Total vs hemiaortic arch transposition for hybrid aortic arch repair. J Vasc Surg. 2011;54:1182–6.
Eggebrecht H, Thompson M, Rousseau H, et al. Retrograde ascending aortic dissection during or after thoracic aortic stent graft placement: insight from the European registry on endovascular aortic repair complications. Circulation.2009;120:S276–81.
Lin J, Marrocco C, Galovich J, et al. Experience with early TEVAR treatment of uncomplicated type B aortic dissection. J Cardiovasc Surg. 2013; 54 :161–72.
Acknowledgements
We acknowledge Dr. Suresh V, Faculty, Department of community medicine, SRMC&RI, Chennai, for helping us with statistical analysis.
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This is a retrospective study involving human and has been cleared by our Institutional Ethical Committee.
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Idhrees, M., Krishnaswami, M., Jacob, A. et al. Hybrid aortic arch repair: 10-year experience from India. Indian J Thorac Cardiovasc Surg 35 (Suppl 2), 156–163 (2019). https://doi.org/10.1007/s12055-018-0689-0
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DOI: https://doi.org/10.1007/s12055-018-0689-0