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Updated: May 22, 2026
Novel and Innovative Hybrid Technique for Type A Aortic Dissection
Published on: March 28, 2025
Six-year experience with a hybrid stent graft prosthesis for extensive thoracic aortic disease: an interim balance
Heinz Jakob1, Daniel-Sebastian Dohle, Jarowit Piotrowski
1Department of Thoracic and Cardiovascular Surgery, West-German Heart Center, University of Duisburg-Essen, Essen, Germany. heinz.jakob@uk-essen.de
Insights
Hybrid stent grafts offer a feasible one-stage repair for complex thoracic aortic disease, demonstrating acceptable mortality and infrequent reintervention. This approach simplifies treatment for ascending, arch, and descending aorta conditions.
Area of Science:
- Cardiovascular Surgery
- Vascular Surgery
- Medical Devices
Background:
- Complex thoracic aortic disease often requires staged surgical interventions, increasing patient mortality and morbidity.
- A hybrid stent graft prosthesis enables simultaneous repair of the ascending, arch, and descending aortas.
- This technique utilizes a proximal surgical suture line with an integrated distal stent graft for downstream support.
Purpose of the Study:
- To evaluate the mid-term outcomes of a single-centre experience with hybrid stent graft repair for complex thoracic aortic disease.
- To assess the feasibility, safety, and efficacy of a one-stage hybrid repair approach.
- To determine the incidence of major adverse events and long-term survival rates.
Main Methods:
- A cohort of 77 patients with acute aortic dissection (AAD), chronic aortic dissection (CAD), or thoracic aortic aneurysms (TAA) underwent one-stage hybrid repair between January 2005 and March 2011.
- Follow-up included repeat aortic computed tomography imaging at a mean of 29 months.
- Major adverse events (MAEs) were defined as permanent stroke, spinal cord injury, and dialysis.
Main Results:
- In-hospital mortality was 10%. MAE incidence was 5% in AAD, 13% in CAD, and 20% in TAA.
- Complete thrombosis of the thoracic false lumen was achieved in 92% (AAD) and 91% (CAD), with 100% aneurysm exclusion in TAA.
- Five-year survival was 79%, with 93% freedom from aortic disease-related death. Freedom from distal reoperation was high across all groups (94-100%).
Conclusions:
- The hybrid one-stage repair is a feasible and durable option for complex thoracic aortic disease, associated with acceptable mortality.
- Distal reintervention rates are infrequent and carry low risk, supporting the expanded use of endovascular techniques for peripheral flow optimization.
- This approach offers a valuable alternative to staged procedures, improving outcomes for patients with extensive aortic pathology.
Objectives:
To avoid a two-stage surgical approach for complex thoracic aortic disease with its additive mortality and morbidity, a hybrid stent graft prosthesis was introduced 6 years ago for simultaneous treatment of the ascending, arch and descending aortas, relying proximally on a surgical suture line with an integrated distal stent graft for downstream splinting. We report the mid-term single-centre experience.
Methods:
Between January 2005 and March 2011, 77 patients (mean age 59 years, male 75%) with acute (AAD, n = 39) or chronic aortic dissection (CAD, n = 23) DeBakey type I or an extensive thoracic aortic aneurysm (TAA, n = 15) underwent one-stage repair. Periodic follow-up studies (100%, mean 29 months) included repeat aortic computed tomography imaging. Major adverse events (MAEs) were defined as permanent stroke, spinal cord injury and dialysis.
Results:
In-hospital mortality was 10% (8 of 77). The incidence of MAE in AAD, CAD and TAA was 5, 13 and 20%, respectively. At the last follow-up, the complete thrombosis of the thoracic false lumen was 92% for AAD, 91% for CAD and the full exclusion of aneurysms 100% in TAA. Throughout the follow-up, freedom from aortic disease-related death was 93% and 5-year survival 79%. Freedom from distal reoperation was 94% in AAD, 95% in CAD and 100% in TAA and the incidence of distal stent graft extension 10% (8 of 77).
Conclusions:
The durable hybrid one-stage repair of complex thoracic aortic disease is feasible with acceptable mortality. Distal reintervention is infrequent and associated with low risk; thus, the indication for the optimization of the peripheral flow using the endovascular aortic repair techniques is gradually widened.
