Original articleAdult cardiac“Hybrid” Repair of Aneurysms of the Transverse Aortic Arch: Midterm Results
Section snippets
Patients and Methods
Between March 23, 2005 (date of Food and Drug Administration approval of the first available thoracic device in the United States) and October 23, 2008, 178 thoracic endograft procedures were performed at our institution. Of these, 28 (16%) were hybrid arch repairs (performed between August 11, 2005 and September 18, 2008) and form the basis of this report. Indications for surgery included either saccular (n = 11) or fusiform (n = 17) aneurysms of the transverse arch. In 10 patients (36%), the
Patient Demographics
Mean aneurysm diameter was 6.1 ± 1.6 cm (range, 3.1 to 11.0 cm). Patient demographics are presented in Table 1. Eleven (39%) had undergone prior open aortic surgery, including prior ascending aortic replacement for type A dissection in 6 (21%). The distal extent of aortic coverage by the endografts was above T6 in 18 (64%) and below T6 in 10 (36%). Thirteen (46%) of the patients were symptomatic with pain symptoms; 21% (6 of 28) of the cases were urgent (aneurysm repaired during the same
Comment
Aneurysms of the transverse aortic arch, especially those involving the mid to distal arch, are technically challenging to repair with conventional open techniques. These challenges relate to difficulties with exposure, need for deep hypothermic circulatory arrest, and frequent requirement for a two-stage approach to complete repair. Total arch replacement, although now performed routinely and safely in centers with expertise, still carries a perioperative death or stroke rate approaching 15%,
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Long-term outcomes for hybrid aortic arch repair
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2023, Journal of Thoracic and Cardiovascular SurgeryCitation Excerpt :Type I HAR involves head vessel reimplantation (“debranching”) via a multibranched graft (Gelweave Trifurcate Arch Graft; Terumo Aortic) from the ascending aortic Dacron graft placed at the time of index ATAAD repair with subsequent exclusion of the arch pathology via endograft(s) with PLZ in the preexisting Dacron ascending aorta (zone 0; Figure 2); the technique has previously been described in detail (Video 1).18 Although the arch debranching and TEVAR portions of the procedure can be performed concurrently using either antegrade or retrograde endograft delivery, performing these cases in 2 stages during a single hospital stay has evolved as the preferred technique.11,19 Likewise, performing the first-stage arch debranching procedure using beating heart cardiopulmonary bypass (CPB) is now preferred, because this facilitates obtaining very proximal exposure of the existing ascending Dacron graft for the site of the proximal anastomosis of the arch debranching graft and thereby maximizes the potential PLZ for the endografts.18
Single-stage hybrid total arch replacement for extended arch aneurysms
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Recipient of the 2008 Clifford Van Meter President's Award.