Hybrid aortic arch repair for complicated type B aortic dissection

Abstract

HAR in zone 1 and 2 appears a viable alternative to conventional aortic arch surgery in patients with complicated type B dissection. Stroke and endoleaks remain complications that need to be addressed. Treatment of type B aortic dissection with complete supra-aortic debranching and thoracic endovascular aortic repair in zone 0, however, is associated with high mortality, which might be reduced by improved technology using branched stent grafts.

Aortic hemiarch hybrid repair

“…Furthermore, especially in patients with dissection, repair of zone 0 might have a higher risk of technical failure or retrograde dissection. 12,22 The stroke rate was also remarkably high in our series (>10%). This might be a result of the highly diseased arch in our group of patients with elevated risk of embolization during wire or device manipulation.…”

“…Nevertheless, there are few data available comparing limited hybrid reconstruction for zone 1 and zone 2 in short-and long-term durability. 9,10,[12][13][14] This study is a single-center, retrospective analysis of patients treated with hemiarch aortic hybrid procedures in zone 1 and zone 2 (zone 0 procedures are excluded).…”

A Simplified Arch Debranching Technique for Hybrid Repair of Complicated Type B Aortic Dissection

“…Hybrid repair has been introduced as a promising option to avoid open surgical procedures in such challenging anatomic configurations [3]. It can achieve effects similar to those of open surgical repair of thoracic aortic pathologic conditions, and meanwhile it reduces the use of cardiopulmonary bypass and circulatory arrest [4].…”

“…The procedure was performed through an extrathoracic approach without median repeated sternotomy, cardiopulmonary bypass, or hypothermic circulatory arrest and mainly involved a simplified arch debranching technique. Compared with a conventional arch debranching technique, LSCA revascularization is indispensable when a dominant LVA originates from the LSCA [3,5]. Anatomic studies have reported that 60% of patients have a dominant LVA, with the right vertebral artery being smaller, atretic, or completely absent.…”

“…involving repeated sternotomy is technically challenging and is associated with a high risk of catastrophic hemorrhage and death [1,2]. Hybrid repair, which consists of arch debranching and endovascular aortic repair, has been shown to be a promising option for the treatment of complex aortic dissection [3]. Convenient procedures and fewer postoperative adverse events of an arch debranching technique are important factors that need to be considered for assured outcomes of hybrid repair.…”