Analysis of clinical outcomes of one‐staged hybrid procedure without thoracotomy for aorta lesion involving distal aortic arch

Abstract

Background This study aimed to evaluate the clinical outcomes of one‐staged hybrid procedure for aortic lesions involving the distal aortic arch. Methods We retrospectively studied 99 consecutive patients who underwent the hybrid procedure (thoracic endovascular aortic repair combined with supra‐arch branch vessel bypass) in our center between April 2009 and January 2020 for lesions involving the distal aortic arch. Results Median age was 64.0 (57.0–69.0) years, and 83 (83.8%) patients were male. There were five deaths in the perioperative period (three due to cerebral infarction and two due to intimal rupture). During the median follow‐up of 41.0 months, 20 patients died, three had endoleak, one had a newly formed intimal tear, and two had femoral artery pseudoaneurysm. The 5‐ and 10‐year survival rates of the total population were 72.2% and 48.8%, respectively. Additionally, there was no difference in the 5‐year survival rate among the four groups according to different pathologies (Type B aortic dissection, aortic ulcer, aortic aneurysm, aortic pseudoaneurysm: 74.7%, 78.2%, 61.1%, and 75.5%, respectively, p = .58). Furthermore, there was no difference in the 5‐ and 10‐year survival rates between the two groups according to the different bypass methods (right axillary artery [RAA]‐left axillary artery [LAA] vs. RAA‐LAA‐left common carotid artery: 74.1% vs. 68.9%, p = .38). Conclusions Although one‐staged hybrid procedure has fewer complications in high‐risk patients with lesions involving the distal aortic arch, the long‐term survival rate is not optimistic.