Hybrid Repair Of Aortic Arch Disease:Short-and Mid-term Results Comparing With Open Arch Surgery

Section 1:Early and midterm results after hybrid total arch repair of Stanford type A dissection without deep hypothermic circulatory arrestObjectives:The purpose of this study was to assess the efficacy of the hybrid total arch procedure for the treatment of Stanford type A dissection with early and midterm results.Methods:From November 2009 to September 2014,56 patients with Stanford type A dissection underwent hybrid total arch repair without deep hypothermic circulatory arrest. During the follow-up, computed tomography imaging was performed to evaluate the aortic diameter, true lumen diameter, false lumen diameter and false patency at the following three levels:pulmonary bifurcation, diaphragm and superior mesenteric artery.Results:The hospital mortality rate was 3.6%(2/56 patients). Three patients exhibited type la endoleak during the operation and one patient demonstrated type Ⅱ endoleak 5 days after surgery. During the follow-up, false lumen complete thrombosis was observed at the level of the pulmonary bifurcation in 94% of patients (P＜0.05). At the level of the diaphragm and superior mesenteric artery, false lumen thrombosis was observed in 68% (P＜0.05) and 36% (P<0.05) of patients, respectively. No patient had type Ⅰ or Ⅲ endoleak and no reoperation was related to residual dissected aorta. The actuarial 1-,3-and 5-year survival rates were 96.4% (95%confidence interval,91.5%-100%),92.3% (95% confidence interval,85%-99.6%) and 89.6%(95% confidence interval, 80.8%-98.4%), respectively.Conclusions:For patients with Stanford type A dissection, the hybrid total arch procedure can be safely adopted with good midterm results and with low morbidity and mortality. Longer-term follow-up is required to confirm the viability of this technique.Section 2:Early and midterm results after hybrid repair of aortic arch aneurysmObjectives:The combined open surgical and endovascular approach for the treatment of aortic arch aneurysms has emerged as a safe treatment modality. The purpose of this study was to assess the efficacy of the hybrid approach for the treatment of aortic arch aneurysm with early and midterm results.Methods:From August 2009 to September 2014,18 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 de-branching and ante-grade or retrograde with thoracic endovascular repair (TEVAR) stent grafting of the arch.Results:Mean age was 63±11 years.8 patients had type I repair,10 patients had type II repair. Two patients exhibited type la endoleak. Average cardiopulmonary bypass time was 153±39 minutes, with a stroke rate of 5.6%(n=1).30 days mortality was 5.6%(n=1). The median postoperative hospital stay was 13(7-32) days. The median follow-up was 19 (9-55) months. There were no postoperative endoleak and device migration during the follow-up. Freedom from all-cause mortality was 94.4% and 86.7% at 1,3 years, respectively.Conclusions:The hybrid approach represents an effective option in the treatment of aortic arch aneurysms, with good midterm results. Longer-term follow-up is required to confirm the viability of this technique.Section 3:Current results of hybrid total arch repair versus open total arch replacement for aortic arch diseaseObjectives:This study aims to review the early and mid-term results of a contemporary comparative series of open total arch and hybrid total arch procedures for aortic arch aneurysm and Stanford A dissection.Methods:From August 2009 to September 2014,48 hybrid total arch procedures. During this period 89 traditional total arch replacement were performed. Perioperative and mid-term follow-up outcomes were compared between groups.Results:The hybrid total arch group was older (P<0.05). In the hybrid group, the cardiopulmonary bypass time and duration of aortic cross clamping were lesser(P<0.05) compared the traditional total arch replacement group.The incidence of spinal cord ischemia was similar at 1(2.1%) for the hybrid group and 4(4.5%) for the traditional total arch replacement group.30-day mortality was similar at 1(2.1%)for hybrid group and 2 (2.2%) for the traditional total arch replacement group. There was no significant difference in the incidence of temporary neurologic dysfunction and spinal cord ischemia between the two groups. However, there was a significant difference in endpoints between two groups (P<0.05).Conclusions:Hybrid total arch procedures provide a safe alternative to open repair. High risk patients may be considered for the hybrid approach.