Background
To investigate the outcomes and effectiveness of different types of hybrid aortic
arch repair for aortic dissection involving the aortic arch.
Methods
From 2013 to 2020, 168 patients underwent hybrid aortic arch repair for dissection
involving the aortic arch. We collected data from our electronic medical records,
including the presenting pathology, perioperative details, and postoperative outcomes.
We included the following types of hybrid aortic arch repair: classic type I, type
II, and type III hybrid aortic arch repair, as well as the new type IV hybrid aortic
repair. We defined type IV hybrid aortic arch repair as revascularization of supra-aortic
branches through extra-anatomy bypass without sternotomy, followed by stent-graft
placement.
Results
There were 23, 82, and 63 patients who underwent type I, type II, and type IV hybrid
aortic arch repair, respectively. There were no type III hybrid aortic repairs performed.
Forty-nine cases were performed urgently. The technical success rate was 99.4%. The
early mortality rates of the total group, type I group, type II group, and type IV
group were 6.5%, 4.3%, 8.5%, and 4.8%, respectively. Postoperative complications mainly
included tracheotomy (8.9%), stroke (6%), wound infection (4.2%), renal insufficiency
(8.9%), and endoleak (7.7%). With a mean follow-up of 45.1 ± 28.5 months, the total
1-year and 5-year actual survival rates were 93.5% and 89.0%, respectively. At 6 months,
the aortic diameter at the level of the diaphragm decreased significantly (30.8 ±
4.9 mm vs. 28.5 ± 6.3 mm, P = 0.012), and the rate of thrombosis of the false lumen at the level of pulmonary
bifurcation and diaphragm were 95.7% and 83.1%. Ten patients underwent reintervention
of the aorta, including 7 endovascular reinterventions, 2 total thoracoabdominal aortic
aneurysm repairs, and 1 open total arch replacement. For the total group, the free
from aorta reintervention rate at 5 years was 91.4%.
Conclusion
Our results with hybrid aortic arch repair for aortic dissection involving the aortic
arch are acceptable. The hybrid aortic arch repair could promote thrombosis of the
distal false lumen while excluding intimal tears in the aortic arch.
Keywords
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Article Info
Publication History
Published online: December 22, 2021
Accepted:
November 28,
2021
Received in revised form:
November 14,
2021
Received:
May 10,
2021
Footnotes
Conflict of interest: There were no financial support and conflict of interest.
Identification
Copyright
© 2021 Elsevier Inc. All rights reserved.
