Aortic hemiarch hybrid repair

Abstract

Hemiarch hybrid repair in high-risk patients is associated with an acceptable perioperative mortality risk and long-term survival. Zone 2 represents a feasible and effective treatment option for hybrid arch repair. Zone 1 is related with relevant risk for type Ia endoleak and higher mortality during follow-up. Lifelong surveillance after hybrid repair is essential.

Frozen Elephant Trunk for Acute Type B Dissection Involving the Distal Arch in the Hybrid Repair Era

“…Hybrid techniques involving debranching of the aortic arch vessels and TEVAR through the femoral artery are effective approaches for treatment of type B dissection with aortic arch involvement. Although encouraging results were reported by several studies [8][9][10], postoperative complications (eg, retrograde type-A dissection, stroke, and endoleak) and high inhospital death related to hybrid repair of the aortic arch were troubling problems due to an angulated aortic arch, blockage of the aortic arch vessels, the extent and extension of aortic arch involvement, and nonconformability of the stent graft [11][12][13][14]. Especially, type Ia endoleak was an independent risk factor for early mortality [18].…”

“…The age of aortic dissection onset is significantly lower in China than in developed countries because of low awareness of the disease and poor control of hypertension [26,27], although life expectancy after surgical intervention is longer. To achieve a proper balance between short-and long-term results, the following objectives are important for aortic dissection repair: (1) saving the life of the patient [14]; (2) decreasing the incidence of aortic arch-related complications; and…”

“…Owing to its minimally invasive approach, favorable results of hybrid aortic arch repair have been reported for patients with ATBAD with aortic arch involvement [8][9][10]. However, unsatisfactory results have been reported for ATBAD with aortic arch involvement using hybrid aortic arch repair because complications associated with hybrid aortic arch repair (eg, retrograde type-A dissection, stroke, and endoleak) were very common and inhospital morbidity was relatively high [11][12][13][14]. Therefore, optional management of ATBAD with aortic arch involvement remains controversial [1,3,15].…”

Long-Term Outcomes in Thoracic Endovascular Aortic Repair for Complicated Type B Aortic Dissection or Intramural Hematoma Depending on Proximal Landing Zone

“…Thus, adjunct procedures, such as open or endovascular supra-aortic debranching, are needed to preserve an antegrade perfusion of the left subclavian artery. Supra-aortic debranching brings a relevant risk of stroke and cervical nerve lesions, and extending the aortic covering into the aortic arch is associated with an increased risk for spinal cord ischemia (SCI) as well as retrograde aortic dissection, endoleaks, and aortic rupture [ 9 , 10 ]. Still, there is emerging evidence that a better long-term outcome can be achieved if the stent-graft is placed proximally in zone 2 rather than zone 3 [ 11 , 12 ].…”