Hybrid aortic arch repair: 10-year experience from India

Hybrid aortic arch replacement (HAAR) is emerging as a safe treatment alternative for aortic arch pathologies. HAAR is divided into three groups. We have assessed our outcome for all three types of HAAR.

From January 2007 to December 2016, we have performed 119 endovascular aortic repair (EVAR) of the aorta of which 56 were hybrid aortic arch repair. The hybrid repair entailed aortic arch vessel debranching and concomitant/delayed antegrade ± retrograde EVAR stent grafting of the arch. For group I and II hybrid patients, we debranch the supra-aortic arch vessels without the aid of circulatory arrest. EVAR was performed on the following day. In group III, hybrid antegrade EVAR of the thoracic aorta and arch reconstruction was performed in single stage.

Of the 56 patients, 16 were in group I, 32 in group II, and 8 in group III. Mean age was 59.9 ± 9.4 years with 78.57% (n = 44) being males. Aortic dissection was the primary pathology in 31 (55.36%) patients followed by aneurysm in 24 (42.86%) patients. Marfans syndrome was present in 28.57% (n = 16) patients. Redosternotomy was performed in 10.71% patients (n = 6). Incidence of stroke was 5.38% (n = 3) and there was no patients with renal dysfunction requiring hemodialysis. There were two retrograde aortic dissections and two endoleaks, both in group I patients. Thirty days in-hospital mortality was 5.38% (2 in group I and 1 in group II).

Hybrid aortic arch replacement can be performed with good postoperative outcome. Type II hybrid is better than type I hybrid in our experience. As experience increases, the outcome continues to improve.