Clinical outcomes in hybrid repair procedures for pathologies involving the aortic arch

Zerwes, Sebastian; Leissner, Giesbert; Goßlau, Yvonne; Jakob, Rudolf; Bruijnen, H.; Oertl, F.; Woelfle, K. D.

doi:10.1177/1708538114525608

Cited by 9 publications

(6 citation statements)

References 16 publications

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“…Milewski et al 11 associated or not with ascending aorta replacement or cardiac revascularization, decreases the consistency of literature results for zones 0 to 1 arch repairs. [17][18][19][20] Most of the series including a historical open surgical cohort or endovascular repairs requiring stent graft landing distally or at the origin of LSA (ie, partial arch coverage in zones 3 or 2), with misleading comparison of data. 4 The disparity in analyses for arch populations is even more evident in studies matching open and endovascular arch approaches, due to large variability in selecting the open arch techniques.…”

Section: Discussionmentioning

confidence: 99%

Contemporary comparison of aortic arch repair by endovascular and open surgical reconstructions

Rango

Ferrer

Coscarella

et al. 2015

Journal of Vascular Surgery

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Despite the older age and a higher comorbidity profile in patients with challenging aortic arch disease suitable and selected for endovascular arch repair, no significant differences were detected in perioperative and 4-year outcomes compared with the younger patients undergoing open arch total repair. An endovascular approach might also be a valid alternative to open surgery in average-risk patients with aortic arch diseases requiring 0 to 1 landing zones, when morphologically feasible. However, larger concurrent comparison and longer follow-up are needed to confirm this hypothesis.

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Section: Discussionmentioning

confidence: 99%

Contemporary comparison of aortic arch repair by endovascular and open surgical reconstructions

Rango

Ferrer

Coscarella

et al. 2015

Journal of Vascular Surgery

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“…5,20,21 The results of the current study suggest that hybrid repair of arch aneurysms is generally safe and effective forAorta-specific survival according to procedure type. On long-term follow patients believed to be inappropriate for conventional open arch repair.…”

Section: Discussionmentioning

confidence: 63%

“…The overall survival of the hybrid group in the current study is consistent with that reported by others, with 5-year survivals ranging from 48% to 72%. 7,21-24 …”

Section: Discussionmentioning

confidence: 99%

Evolving practice pattern changes and outcomes in the era of hybrid aortic arch repair

Benrashid

Wang

Keenan

et al. 2016

Journal of Vascular Surgery

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Objective The role of hybrid repair in the management of aortic arch pathology, and long-term outcomes with these techniques, remains uncertain. We report a decade of experience with hybrid arch repair (HAR) and assess institutional practice patterns with regard to the use of hybrid and open techniques. Methods Hybrid and open total and distal arch procedures performed between July 2005 and January 2015 were identified from a prospectively maintained, institutional aortic surgery database. Perioperative morbidity and mortality, freedom from reintervention, and long-term survival were calculated. Hybrid and open procedural volumes over the study period were assessed to evaluate for potential practice pattern changes. Results During the study period 148 consecutive procedures were performed for repair of transverse and distal aortic arch pathology, including 101 hybrid repairs and 47 open total or distal arch repairs. Patients in the hybrid repair group were significantly older with a greater incidence of chronic kidney disease, peripheral vascular disease, and chronic lung disease. Perioperative mortality and outcomes were not significantly different between the hybrid and open groups, aside from decreased median length of stay after hybrid repair. Need for subsequent reintervention was significantly greater after hybrid repair. Unadjusted long-term survival was superior after open repair (70% 5-year survival open vs 47% hybrid; P = .03), although aorta-specific survival was similar (98% 5-year aorta-specific survival open vs 93% hybrid; P = .59). Institutional use of HAR decreased over the final 3 years of the study, with an associated increased use of open total or distal arch repairs. This was primarily the result of decreased use of native zone 0 hybrid procedures. Concurrent with this apparent increased stringency around patient selection for HAR, perioperative morbidity and mortality was reduced, including avoidance of retrograde type A dissection. Conclusions HAR remains a viable option for higher-risk patients with transverse arch pathology with perioperative outcomes and long-term aorta-specific survival similar to open repair, albeit at a cost of increased reintervention. This observational single-institution study would suggest decreased use in more recent years in favor of open repair due to avoidance of native zone 0 hybrid procedures. This decline in the institutional use of native zone 0 hybrid repairs was associated with improved perioperative outcomes.

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“…Stent implantation is either achieved retrogradely through a femoral/iliac conduit or anterogradely through the ascending aorta. 42,43 The position of the proximal end of the endovascular stent graft in the landing zone is critical for the success of the endovascular part of the procedure. A landing zone of at least 1.5-2 cm is recommended for secure endograft delivery.…”

Section: Discussionmentioning

confidence: 99%

“…Access vessels and supra‐aortic vessels are also preoperatively assessed by CT scan. Stent implantation is either achieved retrogradely through a femoral/iliac conduit or anterogradely through the ascending aorta 42,43 . The position of the proximal end of the endovascular stent graft in the landing zone is critical for the success of the endovascular part of the procedure.…”

Section: Discussionmentioning

confidence: 99%

Hybrid repair of aortic arch with zone zero endografting—Case series with review of the literature

Zlatanović¹,

Končar

Sladojević

et al. 2021

Journal of Cardiac Surgery

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Introduction: We present single-institution results of types I and II hybrid procedures for aortic arch disease with 30-day and long-term results and review of the literature.Materials and Methods: This is a retrospective study of all patients that underwent zone 0 endografting and open bypass from ascending aorta to the arch vessels at our institution between January 2013 and 2020. The following data for the systematic review were extracted from eligible studies: 30-day/in-hospital mortality, stroke rate, spinal cord ischemia (SCI) rate, renal failure requiring dialysis, development of retrograde dissection, early (<30 days) types I and III endoleak, follow-up length, late (>30 days) endoleak, and late (>30 days) mortality.Results: Twelve patients underwent hybrid aortic arch treatment in our institution.The most common aortic arch pathology was degenerative aortic aneurysm. The rate of retrograde dissection and SCI was 8.33%. Regarding the literature data, a total of 768 patients undergoing types I and II hybrid aortic arch debranching procedure. The pooled rate of 30-day/in-hospital mortality was 10.96% (95% confidence interval [CI], 8.21-14.06), SCI pooled rate was 2.91% (95% CI, 1.76%-4.33%), and retrograde dissection pooled rate was 3.22% (95% CI, 1.99-4.72). Conclusion:Hybrid arch techniques provide safe alternative to open repair with acceptable short-and midterm results.

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Clinical outcomes in hybrid repair procedures for pathologies involving the aortic arch

Abstract: In severely ill patients with complex aortic diseases, hybrid therapy may offer a promising alternative to conventional open repair.

Cited by 9 publications

References 16 publications

Contemporary comparison of aortic arch repair by endovascular and open surgical reconstructions

Contemporary comparison of aortic arch repair by endovascular and open surgical reconstructions

Evolving practice pattern changes and outcomes in the era of hybrid aortic arch repair

Hybrid repair of aortic arch with zone zero endografting—Case series with review of the literature

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