One-stage triple hybrid arch debranching

Area of Science:

• Cardiovascular Surgery
• Vascular Surgery
• Thoracic Surgery

Background:

• Complex aortic arch and descending aortic disease traditionally necessitate a two-stage surgical intervention.
• Surgical repair of aortic aneurysms and dissections, particularly in syndromic patients, presents significant challenges.

Observation:

• A 31-year-old woman with Marfan syndrome and a history of complex cardiac surgery presented with a 6 cm distal arch aneurysm and thoracic aortic dissection.
• The patient had previously undergone a Ross procedure and a redo sternotomy with valve conduit placement.

Findings:

• A novel one-stage, triple hybrid, off-pump arch debranching with endovascular stent grafting was successfully performed.
• Two GORE Hybrid Vascular Grafts facilitated primary revascularization of the left subclavian artery, obviating the need for a carotid-subclavian shunt.
• The patient experienced no complications and demonstrated a favorable outcome at 3 months postoperatively.

Implications:

• This one-stage approach is a feasible and effective strategy for managing complex aortic arch disease.
• This technique simplifies surgical management and may reduce patient morbidity associated with traditional two-stage repairs.
• Further investigation into this hybrid technique for complex aortic pathologies is warranted.