Late complications after hybrid aortic arch repair

Abstract

Objective: Although hybrid arch repair has gained widespread application as an alternative option for high-risk patients, concerns about its long-term durability remain an important issue. The aim of this study was to investigate late complications after hybrid arch repair.Methods: From January 2002 to December 2017, hybrid arch repair was performed in 65 patients with aortic arch disease (median age, 66.1 years; range, 41-86 years). Hybrid arch repair was defined as debranching involving at least one supraaortic vessel bypass and simultaneous or staged endovascular thoracic stent grafting. We retrospectively analyzed late complications including reintervention, open conversion, and aortic-related death. The median follow-up period was 60.1 months (range, 1-170 months).Results: The in-hospital mortality rate was 6% (4/65). Except for early death (n ¼ 4) and early open conversion (n ¼ 2), late complications were observed in 25 patients (25/59 [42%]). The median time interval between the initial procedure and late complication was 36.6 months (range, 1-92 months). Late complications included delayed type I endoleak (n ¼ 8), distal stent-induced new entry (n ¼ 3), stent migration (n ¼ 3), retrograde type A dissection (n ¼ 2), aortopulmonary fistula (n ¼ 2), aortoesophageal fistula (n ¼ 1), stent fracture (n ¼ 1), infection (n ¼ 1), and sudden death (n ¼ 4). Six of these patients (10%) underwent late open conversion. The overall survival rates at 3 years and 6 years were 71.1 6 7.4% and 57.2 6 11.3%, respectively. The aortic event-free rates at 3 years and 6 years were 52.1 6 7.3% and 39.4 6 10.3%, respectively.Conclusions: Late complications in hybrid arch repair occurred in a substantial proportion of patients during midterm follow-up. Regardless of zone type, the incidence of late complications was relatively high. This study suggests that timely reintervention and open conversion are important for rescuing patients, but repeated reinterventions and conservative strategies are not recommended. Aggressive management and life-long surveillance after hybrid arch repair are mandatory for better outcomes. (J Vasc Surg 2019;70:1023-30.)

Hybrid Repair versus Conventional Open Repair Approaches for Aortic Arch Disease: a Comprehensive Review

“…Preventza et al [ 15 ] provided clinical data that showed unfavorable outcomes for patients who underwent total arch replacement and had previous diagnose of congestive heart failure, history of smoking and/or previous heart disease. In more recent publications, both techniques had similar results and outcomes in the short term, but in the long term-considered a post-procedure time greater than 5 years-total open aortic repair still remains the gold standard treatment for arch diseases, as noted by Joo et al [ 27 ] . In the HR group, a slightly increase in the incidence of permanent neurological deficits was noted, suggesting that cerebrovascular embolic events are a concern even in less invasive approaches.…”

“…Another clinical outcome evaluated by one of the studies was related to postoperative pulmonary function complications, which can occur in up to 30% of the patients undergoing thoracotomy to aortic arch repair. Joo et al [ 27 ] showed that respiratory complications were less important in the HR group, which is justified by less manipulation of the lung parenchyma through thoracotomy, in addition to a lower risk of bleeding and edema. Moreover, the prolonged period of mechanical ventilation and tracheostomy had greater impacts on patients in the COR group.…”

Analysis of clinical outcomes of one‐staged hybrid procedure without thoracotomy for aorta lesion involving distal aortic arch

“…This might be due to the lack of regular CTA follow‐up of all the patients. The anatomical characteristics, including the angulation, high blood flow, and substantial pulsatile movement, of the area where the stent is deployed contribute to the stent‐related complication 20 …”

One-stage hybrid procedure for distal aortic arch disease: mid-term experience at a single center

“…Moreover, the high rates of postoperative complications and reintervention seriously affect patient prognosis. According to the literature, 42% of patients develop late complications (12), and 32% of patients undergo reintervention during the follow-up (13). New lesions in degenerative aortic disease (12), open reintervention increases the risk of death for these high-risk patients due to the complexity of complications.…”