Hybrid aortic arch repair procedure: reinforcement of the aorta for a safe and durable landing zone

Abstract

Objectives: Hybrid aortic arch repair procedure was introduced to reduce invasiveness in high-risk patients with aortic arch pathology. The good results are expanding its application, but endoleak, particularly type I, remains its Achilles' heel.

Design: We describe our experience with hybrid treatment of aortic arch diseases focussing on techniques and results to avoid type I endoleak.

Materials and methods: A total of 15 high-risk patients with zone 0-2 aortic arch pathology underwent supra-aortic debranching on ascending aorta and proximal aortic arch reinforcement with a Dacron prosthesis. Metachronously, the procedure was completed with endovascular stent grafting (ESG).

Results: Median age was 70 years with a mean European System for Cardiac Operative Risk Evaluation (EuroSCORE) of 12.7±6.8. One patient died between aortic debranching and ESG. Mean time between surgical debranching and ESG was 32±27.7 days. No major neurological events occurred. Mean length of the landing zone for ESG was 3.8±0.8 cm. Computed tomography (CT) angiography scan performed soon after operation, and at 3, 6, and 12 months did not show any type I endoleak.

Conclusions: Supra-aortic debranching on ascending aorta with proximal aortic arch reinforcement is a useful step to ensure a safe landing zone for ESG, reducing risk early to midterm of endoleak. Longer term follow-up is required to confirm the viability of this technique.