One-stage hybrid procedure for distal aortic arch disease: mid-term experience at a single center

Chen, Suwei; Zhong, Yongliang; Qiao, Zhiyu; Li, Cheng-Nan; Ge, Yipeng; Qi, Rui-Dong; Hu, Haiou; Sun, Lu

doi:10.21037/jtd-20-2338

Cited by 5 publications

(5 citation statements)

References 37 publications

(39 reference statements)

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“…[9] Another Chinese study reported 78.3% survival rate at seven years. [10] One of the main advantages expected from the antegrade perfusion and avoiding or limiting the TCA durations is to decrease the postoperative stroke rate. Our analysis is another contribution in this regard with a 5% stroke rate postoperatively.…”

Section: Discussionmentioning

confidence: 99%

Branch-first approach in aortic dissection: Initial results

Mert¹

2022

Turk J Vasc Surg

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Objectives: This study aims to evaluate the outcomes of "branch-first" approach in aortic arch repair in aortic dissection for the first time in Türkiye.Patients and methods: Between January 2015 and December 2021, a total of 20 patients (18 males, 2 females; mean age: 51.3±11.1 years; range, 36 to 82 years) who underwent surgery for arch branches were retrospectively analyzed. The "branch-first" approach was used for the perfusion strategy and the repair was commenced accordingly. We used innominate artery and femoral artery for most cases as the primary arterial line and the secondary line was performed at one of the arch branches according to the preoperative imaging findings. These areas were used for the consecutive branch anastomosis.Results: Overall 30-day mortality occurred in three (15%) patients. Thirteen (65%) patients had postoperative morbidity. Postoperative stroke was seen in one (5%) patient and the most common morbidity was revision surgery for bleeding in five (25%) patients. During follow-up, one patient had debranching graft stenosis (5%), but had no clinical problems. According to the Kaplan-Meier analysis, the mean one-and two-year survival rates were 91.7±8.0% and 78.6±13.9%, respectively. Conclusion:The "Branch-first" technique is a feasible technique for aortic dissection repairs, when the arch branches should be intervened. The mortality is compatible with the literature and the morbidity is low.

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Section: Discussionmentioning

confidence: 99%

Branch-first approach in aortic dissection: Initial results

Mert¹

2022

Turk J Vasc Surg

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“…Open surgery may be the optimal option for patients with complicated chronic type B AD concomitant with aortic arch aneurysms or proximal aortic lesions. In patients diagnosed with non-A non-B AD with LCCA involvement only, LSCA to LCCA transposition or bypass should be performed, followed by TEVAR ( 17 ), and the outcomes are also satisfactory. However, in cases with aortic arch entry or LSCA to LCCA transposition that does not provide a sufficient proximal landing zone, double transposition or total arch rerouting should be considered, but it would also increase the risk of RTAAD ( 18 , 19 ).…”

Section: Discussionmentioning

confidence: 99%

Early and Long-Term Follow-Up for Chronic Type B and Type Non-A Non-B Aortic Dissection Using the Frozen Elephant Trunk Technique

Luo

Zhong

et al. 2021

Front. Cardiovasc. Med.

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Background: This study aimed to evaluate the early and long-term outcomes of a single center using a frozen elephant trunk (FET) procedure for chronic type B or non-A non-B aortic dissection.Methods: From February 2009 to December 2019, 79 patients diagnosed with chronic type B or non-A non-B aortic dissection who underwent the FET procedure were included in the present study. We analyzed operation mortality and early and long-term outcomes, including complications, survival and interventions.Results: The operation mortality rate was 5.1% (4/79). Spinal cord injury occurred in 3.8% (3/79), stroke in 2.5% (2/79), and acute renal failure in 5.1% (4/79). The median follow-up time was 53 months. The overall survival rates were 96.2, 92.3, 88.0, 79.8, and 76.2% at 1/2, 1, 3, 5 and 7 years, respectively. Moreover, 79.3% of patients did not require distal aortic reintervention at 7 years. The overall survival in the subacute group was superior to that in the chronic group (P = 0.047).Conclusion: The FET technique is a safe and feasible approach for treating chronic type B and non-A non-B aortic dissection in patients who have contraindications for primary endovascular aortic repair. The technique combines the advantages of both open surgical repair and endovascular intervention, providing comparable early and long-term follow-up outcomes and freedom from reintervention.

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“…A detailed flow chart showing study inclusion is shown in Figure 1 . A multidisciplinary team decided whether to perform the hybrid or open procedure, and the specific evaluation factors have been described in detail in our previously study ( 8 ). Since the hybrid extra-anatomic technique is used to treat high-risk patients, the patient backgrounds may be different between the HAR and SET groups.…”

Section: Methodsmentioning

confidence: 99%

“…In Zone 2, only the extra-anatomic bypass from the RAA to the LAA was established with a straight GORE-TEX ® prosthetic graft. A transfemoral TEVAR procedure was initiated after the establishment of the extra-anatomic bypass ( 8 , 9 ). The diameter of the aortic arch was measured again by aortic angiography.…”

Section: Methodsmentioning

confidence: 99%

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Comparison of Open Repair vs. the One-Stage Hybrid Extra-Anatomic Technique for Distal Aortic Arch Disease Treatment: Mid-term Outcomes With a Risk-Adjusted Analysis

Qiao

Chen

Guo

et al. 2021

Front. Cardiovasc. Med.

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Objective: This study aims to compare the short- and mid-term outcomes of the stented elephant trunk (SET) procedure combined with supra-arch branch reconstruction and one-stage hybrid arch repair combined thoracic endovascular aortic repair (TEVAR) with extra-anatomic bypass in the management of distal arch disease.Methods: From January 2009 to January 2019, 97 patients underwent one-stage hybrid arch repair combined with TEVAR with extra-anatomic bypass (HAR group), and 206 patients underwent the SET procedure with supra-arch branch reconstruction (SET group). We used inverse-probability-of treatment weighting (IPTW) to adjust baseline differences.Results: Before IPTW adjustment, there was no significant difference in operative mortality between the two groups (5.2 vs. 1.0%, P = 0.064). The incidences of stroke, spinal cord injury (SCI), acute kidney injury (AKI), and endoleak also showed no significant differences (4.1 vs. 0.5%, P = 0.066; 2.1 vs. 1.5%, P = 1.000; 0 vs. 1.0%, P = 0.831; 6.2 vs. 1.9%, P = 0.113, respectively). After IPTW adjustment, the incidences of stroke, SCI, and AKI showed no significant differences between the two groups (1.8 vs. 1.1%, P = 0.138; 0.8 vs. 1.6%, P = 0.448; and 0 vs. 0.7%, P = 0.148, respectively). However, the HAR group tended to have higher operative mortality and incidence of endoleak than the SET group (12.4 vs. 1.3%, P = 0.01; 9.9 vs. 1.8%, P = 0.031, respectively). In the multivariate analysis, open repair decreased the risks of endoleak (odds ratio [OR], 0.171, 95% CI, 0.060–0.401; P < 0.001) and operative mortality (OR, 0.093, 95% CI, 0.027–0.238; P < 0.001). The overall survival and event-free survival of the HAR group were significantly lower than those of the SET group (P < 0.001).Conclusion: One-stage hybrid arch repair combined TEVAR with extra-anatomic bypass and the SET procedure with supra-arch branch reconstruction both provided good postoperative treatment outcomes for distal arch disease. However, hybrid arch repair increased the risks of endoleak and operative mortality. The SET procedure provided better mid-term survival than hybrid arch repair without increasing operative mortality. Carefully selecting the indications for the procedure, while receiving close long-term follow-up, may improve the survival rate of patients undergoing hybrid arch repair.

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One-stage hybrid procedure for distal aortic arch disease: mid-term experience at a single center

Cited by 5 publications

References 37 publications

Branch-first approach in aortic dissection: Initial results

Branch-first approach in aortic dissection: Initial results

Early and Long-Term Follow-Up for Chronic Type B and Type Non-A Non-B Aortic Dissection Using the Frozen Elephant Trunk Technique

Comparison of Open Repair vs. the One-Stage Hybrid Extra-Anatomic Technique for Distal Aortic Arch Disease Treatment: Mid-term Outcomes With a Risk-Adjusted Analysis

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