Physician-Modified TEVAR versus Hybrid Repair of the Proximal Descending Thoracic Aorta

Abstract

There are different surgical options for the treatment of proximal lesions of the descending thoracic aorta. The aim of this study was to compare the outcome of physician-modified TEVAR (pmTEVAR) vs. hybrid repair of the thoracic aorta in terms of TEVAR with carotid-subclavian bypass (hdTEVAR). This was a single-centre, retrospective comparative study of all patients who underwent pmTEVAR and hybrid repair of the proximal descending aorta from January 2018 to June 2021. Primary outcomes were technical success, 30-day mortality, perioperative stroke, 30-day reinterventions and supraaortic access related complications. Secondary outcomes were patient survival, late complications, late reinterventions, and bypass/bridging stent patency. A total of 181 patients underwent TEVAR within the period of 42 months. In our study, only patients with proximal landing in zone 2 (n = 39) were included. A total of 5 of 15 pmTEVAR and 8 of 24 hybrid repair operations (33% vs. 33%, respectively) were performed due to aneurysms. Among the rest of the patients, 10 of 15 pmTEVAR and 16 of 24 hybrid operations (67% vs. 67%) were performed due to aortic dissection. Technical success was achieved in 100% of the patients. No significant difference in terms of postoperative complications could be detected in the early and midterm follow up period. The 30-day mortality was 12.5% in the hybrid repair group (n = 3) vs. 6.66% (n = 1) in the pmTEVAR group (p = 0.498). These patients underwent the operation in an emergency setting. No patient died after an elective operation. The causes of early mortality were major stroke (n = 2), haemorrhagic shock (n = 1) in the hybrid group and progredient spinal cord ischemia with tetraplegia and acute respiratory insufficiency (n = 1) in the pmTEVAR group. In conclusion, both therapies are robust techniques, with comparable patency rate and perioperative complications. pmTEVAR appears to be advantageous in terms of operation time and tendency to lower mortality rates.