Hybrid procedure with antegrade stent-graft placement for aortic arch aneurysms: preliminary experience in eight...

To report one-stage hybrid procedures combining debranching surgery and antegrade stent-graft placement in eight patients with aortic arch aneurysms.

Eight patients with atherosclerotic aneurysms (n = 7) or traumatic pseudoaneurysm (n = 1) were enrolled. Proximal landing zones were in zones 1 (n = 2), 2 (n = 5), and 3 (n = 1). In one zone 3 landing (distal to left subclavian artery), hybrid surgery was chosen in view of irregularity of the proximal landing zone.

In six patients with zone 2 and 3 landings, stent grafts were successfully placed through the surgical conduit made near the aortic root without cardiopulmonary bypass or deep hypothermic circulatory arrest. As the two patients with zone 1 involvement had an ascending aorta with a large diameter that would have required a stent graft with an oversized proximal end for safe anchoring, the proximal ascending aorta was transected, after which the stent graft was successfully placed into the transected aortic lumen; the proximal end of the stent graft was then sutured to the ascending aorta under cardiopulmonary bypass and selective cerebral perfusion. One patient died after the procedure of acute myocardial infarction. Neurologic complications occurred in three patients: one showed complete recovery and the other two showed substantial improvement. Minimal endoleak was observed at the proximal site of the stent graft in one patient.

The hybrid procedure with antegrade stent-graft placement is feasible for the treatment of aortic arch aneurysms. Although cardiopulmonary bypass and deep hypothermic cardiopulmonary arrest were avoided in most patients, the rate of neurologic complications suggests the need for further refinement to improve the safety of the technique.