Hybrid aortic arch repair: 10-year experience from India

Area of Science:

• Cardiovascular Surgery
• Vascular Surgery
• Minimally Invasive Procedures

Background:

• Hybrid aortic arch replacement (HAAR) is an evolving technique for managing complex aortic arch pathologies.
• HAAR combines open surgical debranching with endovascular stent grafting for a less invasive approach.

Purpose of the Study:

• To evaluate the outcomes of three distinct types of hybrid aortic arch replacement (HAAR).
• To compare the efficacy and safety of different HAAR techniques in a clinical setting.

Main Methods:

• A retrospective analysis of 56 patients undergoing HAAR between January 2007 and December 2016.
• Patients were categorized into three groups based on the surgical approach: Group I, II (staged debranching and EVAR without circulatory arrest), and Group III (single-stage antegrade EVAR and arch reconstruction).
• Data collected included patient demographics, pathologies, procedural details, and postoperative complications.

Main Results:

• A total of 56 patients (mean age 59.9 years, 78.57% male) underwent HAAR for aortic dissection (55.36%) or aneurysm (42.86%).
• The 30-day in-hospital mortality was 5.38% (3 patients), with a stroke incidence of 5.38% (3 patients).
• Group I experienced two retrograde aortic dissections and two endoleaks; no patients required hemodialysis.

Conclusions:

• Hybrid aortic arch replacement is a viable treatment option with favorable postoperative results.
• Type II hybrid procedures demonstrated superior outcomes compared to Type I in this cohort.
• Continuous improvement in outcomes is observed with increasing surgical experience.