Treatment of aortic arch aneurysms: Open surgery or hybrid procedure?

Abstract

ÖZAmaç: Bu çalışmada arkus aort anevrizmalarının tedavisinde hibrid işlem ve açık cerrahi sonuçları karşılaştırıldı.Ça lış mapla nı:Ocak 2004 -Ocak 2010 tarihleri arasında arkus aort anevrizması nedeniyle total arkus aort replasmanı yapılan 26 hasta (21 erkek, 5 kadın; ort. yaş 56.6±12.4 yıl; dağılım, 20-83 yıl) retrospektif olarak değerlendirildi. Hastalar açık konvansiyonel cerrahi grubu (grup 1, n=15) ve hibrid işlem (aynı seansta total arkus aort debranching ve endovasküler stent implantasyonu) grubu (grup 2, n=11) olarak iki gruba ayrıldı. Sağkalım oranları ve tekrar ameliyat gereksinimi gruplar arasında karşılaştırıldı. Bul gu lar:Ameliyat sonrası revizyon, ekstübasyon süresi ve drenaj miktarları açısından hibrid işlem daha iyi bulundu. Ancak sağkalım oranları, tekrar ameliyat gereksinimi ve ciddi advers kardiyovasküler olaylar açısından gruplar arasında istatistiksel olarak anlamlı bir fark yoktu.So nuç: Çalışma sonuçlarımız arkus aort anevrizması nedeniyle total arkus aort replasmanı yapılan hastalarda sağkalım ve kısa ila orta dönem sonuçlar açısından açık konvansiyonel cerrahi ve hibrid işlemin benzer olduğunu göstermektedir.Anah tarsöz cük ler: Arkus aort anevrizması; konvansiyonel açık cerrahi; hibrid işlem. ABSTRACTBackground: This study aims to compare the results of hybrid procedure and open surgery for the treatment of aortic arch aneurysms. Methods:Twenty-six patients (21 males, 5 females; mean age 56.6±12.4 years; range, 20 to 83 years) who underwent total aortic arch replacement for aortic arch aneurysm between January 2004 and January 2010 were retrospectively analyzed. The patients were divided into two groups: open conventional surgery group (group 1, n=15) and hybrid procedure (total debranching of the aortic arch and simultaneous endovascular stent) group (group 2, n=11). Survival rates and need for reoperation were compared between the groups.Results:The hybrid procedure was found to be more favorable in terms of postoperative revision, extubation period, and drainage amounts. However, there was no statistically significant difference in the survival rates, need for reoperation, and major adverse cardiovascular events between the groups. Conclusion:Our study results suggest that conventional open surgery and hybrid procedure are similar in terms of survival and short-to-mid-term results in patients undergoing total aortic arch replacement for aortic arch aneurysm.

Aortic Arch Repair Using Open and Hybrid Techniques: A Systematic Review

“…When assessing short-term mortality, 10 of the 12 studies (Table 6) evaluated operative mortality, in-hospital mortality, or 30-day mortality. All studies found no difference in short-term mortality, [17][18][19][20][21][22][23][25][26][27] and these findings persisted in studies that performed matching. 18,20,22 Short-term mortality across all studies ranged from 0% to 30% in the open operation cohort and 0% to 23% in the hybrid operation cohort.…”

“…When reviewing LOS, 9 of the 12 studies (Table 5) evaluated LOS among patients undergoing conventional open approach compared to those undergoing hybrid approach. [17][18][19][20]22,[24][25][26][27] We have divided these studies into those evaluating hospital LOS and intensive care unit (ICU) LOS (Table 5). Hospital LOS was shorter in patients undergoing hybrid arch replacement compared to open in most studies, [18][19][20]24,25 while few studies found no difference, 22,26 and no studies found hybrid arch replacement to be associated with longer hospital LOS.…”

“…18,20,22 Short-term mortality across all studies ranged from 0% to 30% in the open operation cohort and 0% to 23% in the hybrid operation cohort. Studies reporting mortality rates at the upper limit of the open arch range were those that had the smallest open cohort sample sizes, 17,19,23,[25][26][27] while those with larger sample sizes had short-term mortality rates approaching 0%. 18,[20][21][22]…”

Usage of elephant trunk stent‐graft in type 1 aortic dissections: How necessary is this?

“…Of course, TEVAR can be an option if reentry tears are wished to be closed afterward. 7 In light of all these knowledge, we assume that indications of elephant trunk procedures cover a limited patient population.…”