Hybrid Off-pump Second-Stage Aortic Arch Repair after Type A Dissection

Area of Science:

• Cardiovascular Surgery
• Vascular Endovascular Therapy
• Aortic Aneurysm Repair

Background:

• Postdissection aneurysms in the aortic arch can develop after acute type A dissection repair.
• These aneurysms often require reoperation due to false lumen perfusion.
• Patients with high comorbidities may not be candidates for standard frozen elephant trunk surgery.

Purpose of the Study:

• To evaluate the efficacy and safety of a hybrid technique for reoperating on postdissection aneurysms.
• To assess outcomes in patients unsuitable for frozen elephant trunk surgery.

Main Methods:

• A hybrid approach involving median resternotomy, ascending to carotid bypass, and transfemoral thoracic endovascular aneurysm repair (TEVAR) was used.
• Nine high-risk patients (EuroSCORE II 13%, logistic EuroSCORE I 45%) were treated without cardiopulmonary bypass.
• Stent grafts used included Relay NBS or Gore C-TAG.

Main Results:

• Technical success was achieved in all nine patients.
• Mean follow-up was 405 days with no disabling stroke, endoleak, paraplegia, or mortality.
• Complete false lumen thrombosis and significant aneurysm shrinkage (median 13 mm) were observed in the aortic arch.

Conclusions:

• Hybrid TEVAR offers encouraging mid-term results for postdissection aneurysms in patients with comorbidities.
• The used stent grafts demonstrated good performance without migration or endoleaks.
• This technique provides a viable alternative for high-risk patients unsuitable for other complex aortic surgeries.