Objective analysis of midterm outcomes of conventional and hybrid aortic arch repair by propensity-score matching

Hiraoka, Arudo; Chikazawa, Genta; Totsugawa, Toshinori; Tamura, Kentaro; Ishida, Akira; Sakaguchi, Taichi; Yoshitaka, Hidenori

doi:10.1016/j.jtcvs.2016.12.060

Cited by 38 publications

(31 citation statements)

References 25 publications

(37 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The current body of literature comparing hybrid and conventional arch repairs mirrors the series of Hiraoka and colleagues, 1 with acceptable early and midterm results. 4 At present, however, there are limited long-term data available for such ''high-risk'' patients undergoing hybrid repair.…”

mentioning

confidence: 75%

Hybrid aortic arch surgery: Have we reached clinical equipoise?

Atkins

Szeto

2017

The Journal of Thoracic and Cardiovascular Surgery

View full text Add to dashboard Cite

show abstract

mentioning

confidence: 75%

Hybrid aortic arch surgery: Have we reached clinical equipoise?

Atkins

Szeto

2017

The Journal of Thoracic and Cardiovascular Surgery

View full text Add to dashboard Cite

show abstract

“…The delayed occurrence of late complications following hybrid arch repair has been reported. 5,8,14 It is thought that aortic arch-related characteristics and properties, including angulation, highvelocity blood flow, and substantial pulsatile movement, may be an inherent weak point of hybrid arch repair; this weak point may be associated with endoleaks, RTAD, and distal stent graft-induced new entry. This finding suggests that the long-term stability of hybrid arch repair cannot be guaranteed.…”

Section: Discussionmentioning

confidence: 99%

Late complications after hybrid aortic arch repair

Joo

Youn

Kwon

et al. 2019

Journal of Vascular Surgery

View full text Add to dashboard Cite

Objective: Although hybrid arch repair has gained widespread application as an alternative option for high-risk patients, concerns about its long-term durability remain an important issue. The aim of this study was to investigate late complications after hybrid arch repair.Methods: From January 2002 to December 2017, hybrid arch repair was performed in 65 patients with aortic arch disease (median age, 66.1 years; range, 41-86 years). Hybrid arch repair was defined as debranching involving at least one supraaortic vessel bypass and simultaneous or staged endovascular thoracic stent grafting. We retrospectively analyzed late complications including reintervention, open conversion, and aortic-related death. The median follow-up period was 60.1 months (range, 1-170 months).Results: The in-hospital mortality rate was 6% (4/65). Except for early death (n ¼ 4) and early open conversion (n ¼ 2), late complications were observed in 25 patients (25/59 [42%]). The median time interval between the initial procedure and late complication was 36.6 months (range, 1-92 months). Late complications included delayed type I endoleak (n ¼ 8), distal stent-induced new entry (n ¼ 3), stent migration (n ¼ 3), retrograde type A dissection (n ¼ 2), aortopulmonary fistula (n ¼ 2), aortoesophageal fistula (n ¼ 1), stent fracture (n ¼ 1), infection (n ¼ 1), and sudden death (n ¼ 4). Six of these patients (10%) underwent late open conversion. The overall survival rates at 3 years and 6 years were 71.1 6 7.4% and 57.2 6 11.3%, respectively. The aortic event-free rates at 3 years and 6 years were 52.1 6 7.3% and 39.4 6 10.3%, respectively.Conclusions: Late complications in hybrid arch repair occurred in a substantial proportion of patients during midterm follow-up. Regardless of zone type, the incidence of late complications was relatively high. This study suggests that timely reintervention and open conversion are important for rescuing patients, but repeated reinterventions and conservative strategies are not recommended. Aggressive management and life-long surveillance after hybrid arch repair are mandatory for better outcomes. (J Vasc Surg 2019;70:1023-30.)

show abstract

“…Hybrid approaches have been developed to be an alternative to conventional open repair but are still not a more advantageous option, especially for high risk patients. 10,11 Since the hybrid operation room started being used for treatment of aortic diseases at Fuwai Hospital in 2007, a multidisciplinary consultation of vascular surgeons, cardiac surgeons, cardiologists, and anaesthetists has been provided to these patients, who were deemed at high risk of open surgical operation. Ten years ago, the first step was taken to selectively use the HAR (arch debranching þ a proximal Dacron landing zone TEVAR) without DHCA for IAD.…”

Section: Discussionmentioning

confidence: 99%