Hybrid Approach to Management of Complex Aortic Arch Pathologies: A Single-Center Experience in China

The purpose of this study is to summarize a single-center experience and midterm outcomes of a combined supra-aortic debranching and thoracic endovascular aortic repair (TEVAR) for hybrid operation on patients with complex aortic arch disease.

From 2012 to 2015, 43 consecutive patients (37 male and 6 females) who underwent a hybrid operation for complex aortic arch disease were retrospectively analyzed. Of the 43 patients, 12 were diagnosed with type A aortic dissection (AD), 27 with complicated type B AD involving the aortic arch, 2 with aortic arch aneurysm, and 2 with type A penetrating atherosclerosis ulcer.

The patients' mean age was 52.3 ± 11.3 years. Hybrid operation was technically successful in all patients. The overall 30-day mortality and in-hospital mortality rates were 2.3% (1 of 43), with 1 patient dying at days 18 of severe aspiration pneumonia after procedure. Thirty-day paraplegia and stroke were 0%. Complication included 1 newly onset renal insufficiency and type II endoleak. After a median follow-up of 15 months (range, 6-26 months), the overall mortality was 7.1% (3 of 42), with Kaplan-Meier survival estimate of 91% at 1 year. Only one late death was considered aorta-related. computed tomography (CT) scanning was performed at 6 months and annually thereafter, and 2 patients were observed with type Ib endoleak and type II endoleak, respectively. For the patient with type Ib endoleak, distal extension was performed successfully. No late extra-anatomic bypass occlusion and stent-graft migration were found on CT scans or ultrasound.

These initial results suggest that hybrid operation with supra-aortic debranching, and TEVAR is an acceptable treatment option for patients with complex aortic arch disease. Short-term and midterm outcomes are acceptable. Further research with large sample size and long-term follow-up is needed.