Complex aortic arch aneurysm and dissections: hybrid techniques for surgical and endovascular therapy

Abstract

Hybrid approaches to aortic arch disorder continue to evolve as techniques and technology are further refined. Further long-term outcome data on these procedures will delineate their role in the future.

Repair of ascending and transverse aortic arch

“…The incidence of stroke and mortality has been high in several studies; the potential benefits might be greater in elderly, very high-risk patients, with less benefit for younger low-risk patients compared with open approaches. 20 There are others who advocate moderate hypothermia in patients with arch aneurysms with good results. 21 We think that the patient should be protected with the use of profound hypothermia with cardiopulmonary bypass to minimize potential neurologic damage.…”

Is total debranching a safe procedure for extensive aortic-arch disease? A single experience of 27 cases

“…The first stage consisted of supra-aortic trunks debranching to obtain an adequate PLZ for successful stent-graft deployment with a proper sealing. We planned the HP based on the anatomy of the aneurysm and the suitability of the proximal and distal landing zones, as reported in literature [2,3]. Successful stent-graft deployment required a satisfactory PLZ ≥ 20 mm in length.…”

Hybrid cardiovascular therapy: interventional (and surgical) procedures in high-risk patients

“…For this reason, hybrid techniques have evolved that involve open surgical debranching of the aortic arch vessels followed by endovascular exclusion with stent graft placement. A variety of surgical techniques have been described for arch vessel debranching and repair/replacement of proximal or distal landing zones [64,65]. While a full LAD LV APEX Adapted with permission from [51].…”