Techniques and Results of Aortic Arch Hybrid Repair

Abstract

Hybrid reconstruction of the aortic arch has been widely used to extend the indications of endovascular repair in patients with arch and thoracic aneurysms involving the supra-aortic trunks. This technique includes procedures performed using cervical incision, median sternotomy, or both. Hybrid approach can potentially avoid or limit the use of cardiopulmonary bypass and circulatory arrest, which is a requirement with conventional total or hemi-arch replacement. For aneurysms involving the distal arch, extra-anatomical cervical bypasses are usually sufficient to create a suitable landing zone. For the proximal arch, debranching requires a median sternotomy with partial clamping of the aorta with or without cardiopulmonary bypass. A total arch replacement technique with frozen elephant trunk can also be used in patients with no suitable landing zones in the ascending aorta. Large systematic review of the literature reveals 93 % technical success and 12 % mortality. Complications included stroke, paraplegia, and retrograde dissection in 8 %, 4 %, and 5 %, respectively, with an overall endoleak incidence of 17 %. The outcomes are comparable to contemporary results of total open and total endovascular repairs.