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Updated: Aug 25, 2025
Novel and Innovative Hybrid Technique for Type A Aortic Dissection
Published on: March 28, 2025
Ultra-Hybrid Repair: Open Thoracoabdominal Completion After Descending Stent Grafting
Matthew A Thompson1, Ashley M Lowry2, Francis Caputo3
1Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio.
Insights
Staged ultra-hybrid repair combines open and endovascular techniques for extensive aortic disease. This approach offers complementary strategies, even in high-risk patients, demonstrating improved outcomes.
Area of Science:
- Cardiovascular Surgery
- Vascular Surgery
- Aortic Disease Management
Background:
- Extensive aortic disease poses significant challenges for surgical repair.
- Traditional open repair methods often involve extensive procedures and associated risks.
- Hybrid approaches integrating endovascular and open techniques are evolving.
Purpose of the Study:
- To evaluate patient risk profiles and outcomes of staged ultra-hybrid repair for extensive aortic disease.
- To assess the feasibility and safety of combining thoracic stent grafting with open thoracoabdominal repair.
- To characterize the patient population undergoing this complex aortic repair strategy.
Main Methods:
- Retrospective analysis of 92 patients undergoing staged ultra-hybrid repair from 2006 to 2021.
- Inclusion of patients with chronic dissection, degenerative aneurysm, endoleak, or acute type B dissection post-thoracic stent grafting.
- Surgical graft anastomosis to the distal endovascular device in situ.
Main Results:
- Hospital mortality was 7.6%. Key complications included dialysis (20%), tracheostomy (8.7%), stroke (5.7%), and paralysis (6.9%).
- One, three, and five-year survival rates were 80%, 71%, and 66%, respectively.
- Mortality correlated with elevated blood urea nitrogen and greater distance between endograft edge and visceral vessels.
Conclusions:
- Staged ultra-hybrid repair is a viable option for extensive aortic disease, even in high-risk patients.
- This approach effectively integrates open and endovascular repair, reducing the extent of open surgery.
- The findings support the complementary nature of open and endovascular strategies in complex aortic disease management.
Abstract:
To characterize patient risk profiles and outcomes associated with staged ultra-hybrid repair of extensive aortic disease, in which open thoracoabdominal completion was performed after thoracic stent grafting. From 1/2006 to 1/2021, 92 patients underwent open thoracoabdominal repair of chronic dissection (n=58, 63%), degenerative aneurysm (n=28, 30%), endoleak (n=4, 4.3%), or symptomatic acute type B dissection (n=2, 2.2%) after descending thoracic stent grafting (69, 75%), frozen elephant trunk (5, 5%), or both (18, 20%). The surgical graft was sewn to the distal endovascular device in situ, reducing the extent of the open procedure and eliminating the need for hypothermic circulatory arrest. Mean age was 58±13 years, 89 (97%) were hypertensive, 38 (43%) had chronic obstructive pulmonary disease, 63 (72%) were smokers, 20 (24%) had a prior stroke, and 33 (36%) had a suspected or confirmed heritable aortic condition. Hospital mortality was 7.6% (n=7). Complications included dialysis (16, 20%), tracheostomy (8, 8.7%), stroke (5, 5.7%), and permanent paralysis (6, 6.9%). Survival at 1, 3, and 5 years was 80%, 71%, and 66%, respectively. Mortality was associated with higher blood urea nitrogen and longer distance between the distal endograft edge and proximal patent visceral vessel (P=0.004 and .01, respectively). Patients with extensive aortic disease undergoing open aortic repair after thoracic stent grafting are often young with chronic dissection, multiple comorbidities, or a heritable aortic condition. Success of staged ultra-hybrid operations demonstrates open and endovascular repair strategies are complementary, even when performed in a high-risk patient population.
