Hybrid aortic arch repair for dissecting aneurysm

Area of Science:

• Cardiovascular Surgery
• Vascular Surgery
• Interventional Cardiology

Background:

• Chronic dissecting aortic aneurysms involving the aortic arch pose significant treatment challenges.
• Traditional open surgical repair carries high risks.

Purpose of the Study:

• To analyze the outcomes of a combined endovascular and debranching procedure for hybrid aortic arch repair in patients with chronic dissecting aortic aneurysms.
• To evaluate the safety and efficacy of this hybrid approach.

Main Methods:

• Retrospective review of 33 consecutive patients undergoing hybrid aortic arch repair between March 2005 and September 2015.
• Inclusion criteria: aneurysm diameter ≥ 55 mm, rapid aortic growth, or rupture.
• Procedures included complete or partial aortic arch debranching (zones 0, 1, or 2).

Main Results:

• Technical success rate of 97% with no in-hospital deaths.
• 30-day mortality was 3%; overall mortality at mean follow-up of 24.3 months was 12%.
• Major complications included cerebrovascular events (3%), spinal cord ischemia (3%), and retrograde dissection (3%).
• Endoleak rate was 18%, leading to reintervention in 2 patients. Overall reintervention rate was 24%.

Conclusions:

• Hybrid aortic arch repair is associated with acceptable early and midterm morbidity and mortality for dissecting aneurysms, including zone 0 repairs.
• The procedure demonstrates feasibility even in complex cases.
• High rates of reintervention and endoleak necessitate vigilant long-term patient monitoring.