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Updated: Jun 11, 2026
Novel and Innovative Hybrid Technique for Type A Aortic Dissection
Published on: March 28, 2025
Arch replacement and downstream stent grafting in complex aortic dissection: first results of an international
Konstantinos Tsagakis1, Davide Pacini, Roberto Di Bartolomeo
1Department of Thoracic and Cardiovascular Surgery, West-German Heart Center Essen, University Hospital Essen, Hufelandstr. 55, 45122 Essen, Germany. konstantinos.tsagakis@uk-essen.de
Insights
This study shows that combining aortic arch replacement with stent grafting effectively treats complex aortic dissection, achieving high rates of false lumen thrombosis with acceptable surgical risks.
Area of Science:
- Cardiovascular Surgery
- Thoracic Aortic Disease
- Hybrid Surgical Techniques
Background:
- Extensive thoracic aortic disease often requires complex surgical interventions.
- Hybrid approaches combining open repair with endovascular techniques are emerging.
- Complex aortic dissection (AD) presents significant management challenges.
Purpose of the Study:
- To evaluate the early outcomes of a hybrid approach for extensive thoracic aortic disease.
- To assess the efficacy of arch replacement combined with antegrade stent grafting in complex aortic dissection (AD).
Main Methods:
- A multicentre retrospective study using an international registry.
- 106 patients with complex AD (55 acute, 51 chronic) underwent hybrid repair using the E-vita open® stent graft.
- Procedures involved hypothermic circulatory arrest (HCA) and selective antegrade cerebral perfusion (SACP).
Main Results:
- Successful stent-graft deployment into the true lumen in 99% of cases.
- High rates of thoracic false lumen (FL) thrombosis (93%) and thoraco-abdominal FL thrombosis (58%) at follow-up CT.
- In-hospital mortality was 12%, with a 5% rate of new strokes.
Conclusions:
- Combining arch replacement with downstream stent grafting offers a one-stage repair for complex AD.
- This hybrid strategy achieves near-complete thoracic FL thrombosis.
- The procedure can be performed with acceptable perioperative risk.
Objectives:
Arch replacement combined with antegrade stent grafting of the descending aorta represents a hybrid surgical approach for extensive thoracic aortic disease. This multicentre study evaluates the early results of this method in complex aortic dissection (AD).
Methods:
Retrospective data acquisition was achieved by institution of an international registry. A hybrid stent graft with integrated vascular prosthesis for arch replacement (E-vita open®) was used. From January 2005 to March 2009, 106 patients (mean age 57; 77% male) with complex AD (55 acute, 51 chronic) were studied.
Results:
As many as 49/106 (46%) patients underwent emergency surgery. Stent-graft deployment and arch replacement (95 total, 11 subtotal) were performed under hypothermic circulatory arrest (HCA (8±6min) and selective antegrade cerebral perfusion (SACP) (74±23min). Stent-graft placement into the true lumen was successful in all but one case (99%). Ascending aortic replacement was performed in 91/106 (86%), aortic valve repair/replacement in 49/106 (46%), coronary artery bypass grafting (CABG) in 17/106 (16%) and mitral valve repair in 2/106 (2%). Cardiopulmonary bypass (CPB) and cardiac arrest times were 242±64 and 144±44min, respectively. In-hospital mortality was 12% (13/106; six acute, seven chronic AD) and new strokes observed in 5/106 (5%). The false lumen (FL) was evaluated in 96/106 (91%) patients postoperatively. At first follow-up computed tomography (CT)-examination, thoracic FL thrombosis was 93% (76 complete, 13 partial) and 58% (31 complete, 25 partial) in the thoraco-abdominal aorta.
Conclusions:
By combining arch replacement with downstream stent grafting, one-stage repair of complex aortic dissection with almost unanimous thoracic FL thrombosis can be achieved at acceptable perioperative risk.
