Single-stage hybrid total arch replacement for extended arch aneurysms.

Area of Science:

• Cardiovascular Surgery
• Vascular Surgery
• Thoracic Surgery

Background:

• Therapeutic strategies for extended aortic arch aneurysms are evolving with the advent of thoracic endovascular aortic repair.
• Conventional total arch replacement (c-TAR) carries significant risks, particularly for complex aneurysms.

Purpose of the Study:

• To evaluate the short-term outcomes of a single-stage hybrid (s-hybrid) total arch replacement (TAR) for extended aortic arch aneurysms.
• To compare the efficacy and safety of s-hybrid TAR with c-TAR.

Main Methods:

• A retrospective review of 62 patients undergoing elective TAR between 2008 and 2017.
• Comparison of perioperative outcomes between 15 patients who underwent s-hybrid TAR and 47 patients who underwent c-TAR.
• Both groups utilized axillary arterial perfusion and selective antegrade cerebral perfusion under moderate hypothermia.

Main Results:

• S-hybrid TAR was successfully completed in all 15 patients.
• The s-hybrid group demonstrated shorter durations of myocardial ischemia, cerebral perfusion, and lower body circulatory arrest.
• Fewer complications such as recurrent laryngeal nerve palsy and prolonged ventilation were observed in the s-hybrid group.
• In-hospital mortality was 6.7% for s-hybrid TAR versus 0% for c-TAR; no substantial endoleaks or permanent paraplegia occurred.

Conclusions:

• S-hybrid TAR exhibits equivalent or improved perioperative outcomes compared to c-TAR for extended aortic arch aneurysms.
• This technique may mitigate respiratory failure associated with thoracotomy and reduce rupture risks in staged procedures.