The efficacy and short-term results of hybrid thoracic endovascular repair into the ascending aorta for aortic arch pathologies.

OBJECTIVES

Conventional total aortic arch repair is a high-risk procedure, particularly for high-risk patients. Although endovascular treatment of aortic arch aneurysm is a recently induced procedure, only a few cases are indicated and outcomes are questionable. Here, we report on the early and short-term results of our surgical procedure, i.e. hybrid arch repair with supra-aortic debranching and endografting into the ascending aorta.

METHODS

Of the 514 patients who underwent arch repairs from 1997 to March 2012, 40 (28 males; mean age 74.4 years) were high-risk patients for whom hybrid arch repair of the ascending aortic landing zone was performed. Aortic pathologies included 31 degenerative aneurysms (including two ruptures), three type A dissections and four type B dissections. We performed supra-aortic debranching from the ascending aorta and endografting into the ascending aorta in 28 patients (including 10 patients with graft replacements and 3 patients with banding of the ascending aorta). For the 12 patients with an ascending aorta diameter of <36 mm, the chimney graft technique into the innominate artery was performed.

RESULTS

The 30-day mortality rate was 3%. Postoperative complications were as follows: stroke (0 patient), haemodialysis (1), prolonged mechanical ventilation (2) and spinal cord ischaemia (1). There were one early type I and two type II endoleaks. The mean follow-up duration was 15.5 months, during which freedom from aorta-related death and aortic events were 91 and 89% at 3 years.

CONCLUSIONS

We achieved satisfactory early and short-term results with hybrid arch repair into the ascending aorta. Our findings suggest that hybrid repair into the ascending aorta may be a viable option for high-risk patients with aortic arch pathologies.