The Visceral Hybrid Repair of Thoraco-abdominal Aortic Aneurysms – A Collaborative Approach

Drinkwater, S L; Böckler, Dittmar; Eckstein, H.‐H.; Cheshire, Nick; Kotelis, Drosos; Wolf, Oliver T.; Hamady, Mohamad; Geisbüsch, Philipp; Clark, Martin; Allenberg, Jens-R.; Wolfe, John H.; Gibbs, Richard; Jenkins, Michael

doi:10.1016/j.ejvs.2009.07.002

Cited by 92 publications

(76 citation statements)

References 20 publications

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“…This debate is further enhanced by the heterogeneity of the morbidity and mortality rates among different medical centers. In a series of 107 patients, one of the larger reported in literature, Drinkwater et al 25 described a mortality rate of 14.9%. The most promising outcome was reported by Quinones-Baldrich et al, 21 with a 0.0% mortality rate in a series of 15 patients.…”

Section: Discussionmentioning

confidence: 99%

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Hybrid Open Endovascular Technique for Aortic Thoracoabdominal Pathologies

et al. 2011

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Background-Many authors using a hybrid debranching strategy for the treatment of thoracoabdominal pathologies have reported disappointing results and the initial enthusiasm for the technique has given way to criticism and ambiguity. The aim of the present meta-analysis study was to assess the safety and efficacy of the technique in patients with thoracoabdominal aortic aneurysms or other aortic pathologies. Methods and Results-A multiple electronic search was performed on all articles describing hybrid open endovascular repair. Separate meta-analyses were conducted for technical success, visceral graft patency, spinal cord ischemia symptoms, renal insufficiency, and other complications as well as 30-day/in-hospital mortality. Nineteen publications with a total of 507 patients were analyzed. The pooled estimates for primary technical success and visceral graft patency were 96.2% (95% CI, 93.5%-98.2%) and 96.5% (95% CI, 95.2%-97.8%) respectively. A pooled rate of 7.5% (95% CI, 5.0%-11.0%) for overall spinal cord ischemia symptoms was observed; whereas for irreversible paraplegia the pooled rate was 4.5% (95% CI, 2.5%-7.0%). The pooled estimate for renal failure was 8.8% (95% CI, 3.9%-15.5%). The pooled 30-day/in-hospital mortality rate was 12.8% (95% CI, 8.6%-17.0%). During the mean follow-up period of 34.5 (95% CI, 31.5-37.5) months, a total of 119 endoleaks were identified in 111 patients (22.7%). Conclusions-The repair of thoracoabdominal pathologies by means of hybrid procedures in patients who are poor surgical candidates is still associated with significant morbidity and mortality rates. Future studies may substantiate whether the technique is amenable to amelioration and improvement. (Circulation. 2011;124:2670-2680.)

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Section: Discussionmentioning

confidence: 99%

“…A secondary regression analysis of 20 patients in 18 studies who developed irreversible paraplegia 7,8,[13][14][15][16][17][18][19][20][21][22][23][24][25][26][27]29 showed that there was a significant correlation between irreversible paraplegia and death (Pϭ0.002).…”

Section: Spinal Cord Ischemiamentioning

confidence: 99%

Hybrid Open Endovascular Technique for Aortic Thoracoabdominal Pathologies

et al. 2011

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“…Это отсутствие высокого пережатия аор-ты и торакофренотомии [3,12,21,25,32,36,37,44,57,66,69,72,85,87,92]. Первое преимущество позволяет сохра-нить стабильную гемодинамику в течение всей операции [3,44,84,92].…”

Section: преимущества гибридного вмешательства перед открытымunclassified

“…Первое преимущество позволяет сохра-нить стабильную гемодинамику в течение всей операции [3,44,84,92]. Также значительно сокращается время ишемии внутренних органов и реперфузионное повреж-дение [3,25,32,36,44,66,67,73,74,87,92], так как время пережатия каждой артерии составляет менее 15 мин [73,74]. Уменьшается время ишемии печени и, следователь-но, риск коагулопатии [67,74], время ишемии кишок, способствующей бактериальной транслокации через ки-шечную стенку и послеоперационному сепсису [67].…”

Section: преимущества гибридного вмешательства перед открытымunclassified

Cardiovascular surgeon’s role in hybrid aortic surgery (part 2)

Белов¹,

Каравайкин²,

Belov³

et al. 2016

Kardiol. serdechno-sosud. khir.

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“…Although the authors hypothesize that these improved results may be secondary to a learning curve related to the procedure, 2 institutions with no mortality treated relatively low volumes of patients, 10 and 17 patients, whereas the group with the largest series, 107 patients, had a 30-day mortality of 14.9%. 12 If this difference were related purely to a learning curve, one would expect the results to improve with increased numbers of patients.…”

Section: Article See P 2670mentioning

confidence: 99%

Are Improved Results for Hybrid Repair of Thoracoabdominal Aortic Aneurysms Due to a Learning Curve or Better Patient Selection?

Kwolek

2011

Circulation

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pen repair of thoracoabdominal aortic aneurysms (TAAAs) has traditionally been accompanied by significant morbidity and mortality. The use of adjuncts such as hypothermia and selective visceral perfusion has decreased the rates of permanent paraplegia to Ͻ5%, renal failure requiring dialysis to Ͻ5%, and 30-day mortality to Ͻ10% when performed in high-volume centers of excellence. 1,2 However, when this operation is applied across a broad spectrum of institutions, the overall morbidity and mortality can be significantly higher. One statewide registry reported a 1-year mortality rate of 40% when TAAA repair was performed in patients Ͼ75 years of age. 3 In addition, there exists a subset of patients who are considered too high risk for open repair, usually because of the severity of their underlying pulmonary disease and other medical comorbidities. 4 Article see p 2670Thus, vascular interventionalists have searched for less morbid ways to treat these complex patients. The use of thoracic endografts has been demonstrated to decrease the overall morbidity and mortality of patients undergoing repair of both elective and emergent thoracic aortic pathology. 5,6 However, the availability of branched endografts to treat TAAAs involving the visceral vessels has been limited, particularly in the United States. 7,8 Thus, the concept of combining a lesser open abdominal operation to bypass the visceral and renal vessels with the placement of an endovascular stent graft in the descending thoracic aorta has been developed as a hybrid open endovascular technique. As Moulakakis et al 9 point out in this issue of Circulation, no prospective randomized trials have compared hybrid open endovascular technique procedures with standard open TAAA repair, repair using branched endovascular grafts, or even best medical therapy. Current results from multiple single-center series describe a wide range of morbidity and mortality.Moulakakis et al 9 performed a meta-analysis of 19 series published over the past decade describing the results of hybrid TAAA repair in 507 patients. Despite the wide range of outcomes, the pooled estimates for 30-day mortality of 12.8% (95% confidence interval, 8.6 to 17), for irreversible paraplegia of 4.5% (95% confidence interval, 2.5 to 7.0), and for renal impairment requiring dialysis of 8.8% (95% confidence interval, 3.9 to 15.5) seem to provide a realistic expectation of potential outcomes in this high-risk group of patients. 9 We reported a slightly higher 30-day mortality of 17.4% with a comparable paraplegia rate of 4.3% and rates of renal insufficiency similar to that of open repair in a series of 23 high-risk patients undergoing debranching procedures. 4 However, the in-hospital mortality of 26% in our series and 1-year mortality of 32% provide a sobering perspective on the potential long-term risks of hybrid intervention in these patients. These outcomes have certainly caused us to apply this strategy conservatively in patients deemed unfit for open TAAA repair.On the other hand, several institutions ...

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The Visceral Hybrid Repair of Thoraco-abdominal Aortic Aneurysms – A Collaborative Approach

Abstract: These early results of visceral hybrid repair for high-risk patients with complex thoraco-abdominal aortic aneurysms are encouraging, in a group of patients in whom fenestrated/branched stent-grafting is not an option and open surgery hazardous.

Cited by 92 publications

References 20 publications

Hybrid Open Endovascular Technique for Aortic Thoracoabdominal Pathologies

Hybrid Open Endovascular Technique for Aortic Thoracoabdominal Pathologies

Cardiovascular surgeon’s role in hybrid aortic surgery (part 2)

Are Improved Results for Hybrid Repair of Thoracoabdominal Aortic Aneurysms Due to a Learning Curve or Better Patient Selection?

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