Hybrid approaches in the treatment of aortic arch aneurysms: Postoperative and midterm outcomes

作者：Bavaria Joseph^*; Vallabhajosyula Prashanth; Moeller Patrick; Szeto Wilson; Desai Nimesh; Pochettino Alberto

来源：The Journal of Thoracic and Cardiovascular Surgery, 2013, 145(3): S85-S90.

DOI：10.1016/j.jtcvs.2012.11.044

Background: The combined open surgical and endovascular approach for the treatment of aortic arch aneurysms has emerged as a safe treatment modality. This platform may have an especially important role in treating patients of old age and with a greater comorbid burden. We describe our institutional experience with the hybrid aortic arch approach, with midterm outcomes.
Methods: From 2005 to the present, 685 patients have undergone thoracic endovascular repair (TEVAR); 104 had a hybrid arch repair (open plus endovascular approach). Of these, 47 patients had treatment for an aortic arch aneurysm with or without a proximal ascending aortic aneurysm. All these patients had a median sternotomy approach for arch vessel debranching and antegrade with or without retrograde TEVAR stent grafting of the arch. Results from a prospectively maintained database are reported.
Results: Twenty-eight patients had type I repair, 8 patients had type II repair, and 11 patients had type III arch hybrid repair. Those with type III repair were excluded from the analysis. Stent graft deployment rate was 100% after arch vessel debranching. Mean age was 71 +/- 8 years. Fourteen percent of cases involved a redo sternotomy. Average cardiopulmonary bypass time was 215 +/- 64 minutes, with a crossclamp time of 70 +/- 55 minutes and a circulatory arrest time of 19 +/- 10 minutes. The paraplegia rate was 5.5% (n = 2), with a stroke rate of 8% (n = 3). In-hospital mortality was 8% (n = 3). There were no postoperative endoleaks. The mean length of stay was 17.2 +/- 14 days. The median follow-up was 30 +/- 21 months. Freedom from all-cause mortality was 71%, 60%, and 48% at 1, 3, and 5 years, respectively. The aortic reoperation rate was 2.7% (n = 1). No patient has a type 1 or 3 endoleak at latest follow-up.
Conclusions: The hybrid approach to aortic arch aneurysm involving a zone 0 stent graft landing can be safely adopted with good midterm results in a cohort of old patients with significant comorbidity. This procedure can be performed with no type 1 or 3 endoleaks and may represent a technical advancement in the field of aortic arch surgery. (J Thorac Cardiovasc Surg 2013;145:S85-90)

• 出版日期2013-3