[Staged approach for hybrid thoracoabdominal aortic replacement]

Area of Science:

• Vascular Surgery
• Cardiovascular Medicine
• Surgical Innovation

Background:

• Thoracoabdominal aortic aneurysms (TAAA) present complex surgical challenges.
• Hybrid approaches offer potential solutions for high-risk patients.
• Staged hybrid repair aims to mitigate risks associated with traditional open repair.

Purpose of the Study:

• To generalize experience with a step-by-step hybrid thoracoabdominal aortic replacement technique.
• To evaluate the safety and efficacy of a staged hybrid approach for TAAA.
• To identify the advantages of this hybrid strategy, particularly regarding cardiopulmonary bypass.

Main Methods:

• A retrospective analysis of 23 patients undergoing staged hybrid thoracoabdominal aortic repair.
• The procedure involved three stages: proximal debranching, distal (abdominal) debranching, and aortic stenting.
• Patient demographics included 5 women and 18 men, with a mean age of 61.4 years.

Main Results:

• No complications were observed after proximal debranching and aortic stenting stages.
• The abdominal debranching stage resulted in a 13.0% mortality rate (3 patients).
• Early postoperative prosthesis branch occlusion occurred in 3 out of 87 cases.

Conclusions:

• A staged hybrid approach is considered optimal for thoracoabdominal aortic aneurysm treatment, particularly in high-risk individuals.
• The primary advantage identified is the avoidance of cardiopulmonary bypass, reducing procedural risks.
• This technique offers a viable alternative for complex aortic pathologies.