Hybrid aortic arch repair for complicated type B aortic dissection

Area of Science:

• Vascular Surgery
• Cardiovascular Medicine
• Interventional Cardiology

Background:

• Complicated type B aortic dissection presents significant therapeutic challenges.
• Hybrid aortic arch repair (HAR) offers a less invasive approach compared to traditional open surgery.
• The safety and efficacy of HAR, particularly with varying debranching strategies, require detailed analysis.

Purpose of the Study:

• To analyze the outcomes of combined endovascular and debranching procedures for hybrid aortic arch repair (HAR) in patients with complicated type B aortic dissection.
• To compare the results of HAR with complete versus partial supra-aortic debranching.
• To identify complications and long-term survival associated with HAR in this patient cohort.

Main Methods:

• Retrospective analysis of 45 patients with complicated type B aortic dissection who underwent HAR between February 2006 and August 2012.
• Patients were categorized based on the timing of dissection (acute, subacute, chronic) and debranching strategy (complete vs. partial).
• Kaplan-Meier method was used for survival analysis, with descriptive statistics for patient characteristics and outcomes.

Main Results:

• Technical success was achieved in 86.7% of patients.
• In-hospital mortality was significantly higher in patients undergoing complete supra-aortic debranching (67%) compared to partial debranching (2.6%).
• Overall mortality at a median follow-up of 20.8 months was 13.3%, with a 1-year survival estimate of 85%. Stroke occurred in 8.8%, and endoleaks were noted in 27% early and 43% late.

Conclusions:

• Hybrid aortic arch repair in zones 1 and 2 is a feasible alternative for complicated type B aortic dissection.
• Complete supra-aortic debranching in zone 0 is associated with high mortality, suggesting a need for improved techniques like branched stent grafts.
• Stroke and endoleaks remain significant complications requiring further management strategies.