Open Surgical Repair Remains the Gold Standard for Treating Aortic Arch Pathology

Khullar, Vishal; Schaff, Hartzell V.; Dearani, Joseph A.; Daly, Richard C.; Greason, Kevin L.; Joyce, Lyle D.; Pochettino, Alberto

doi:10.1016/j.athoracsur.2016.08.064

Cited by 37 publications

(15 citation statements)

References 20 publications

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“…While traditional open surgery is still considered by some as the gold standard for treatment of extensive aortic arch pathologies (4,5), others have suggested hybrid techniques such as the frozen elephant trunk and aortic arch vessel debranching as more appropriate procedures for high-risk patients, where co-morbidities may contraindicate cardiopulmonary bypass and longer operative times required for traditional repair (6,7). Total-endovascular techniques are also being developed and may soon be a more widely utilized treatment option (8,9).…”

Section: Introductionmentioning

confidence: 99%

Long-term survival and related outcomes for hybrid versus traditional arch repair—a meta-analysis

Chakos¹,

Jbara²,

Yan³

et al. 2018

Ann. Cardiothorac. Surg.

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Background: Surgical interventions for aortic aneurysm and dissection remain associated with high risk of mortality and morbidity. Advances in operative techniques have led to a variety of options for the cardiac surgeon, including endovascular and hybrid approaches. Debate remains over which of these techniques provide optimal outcomes for the patient. The present systematic review and meta-analysis aims to evaluate long term patient survival and identify short-term outcomes for conventional (open) aortic arch repair and hybrid aortic arch repair (HAR).Methods: An electronic literature search was conducted according to predefined inclusion criteria for hybrid and conventional aortic arch repair surgery. Digitized survival data was extracted from identified studies' Kaplan-Meier curves and used to re-create individual patient data for aggregated survival analysis.Post-operative morbidity and mortality were analyzed using random-effects model meta-analysis.Results: Nine studies were included, containing 841 hybrid arch repair and 1,182 conventional arch repair patients. Pooled Kaplan-Meier analysis of all patients demonstrated higher survival in hybrid arch repair patients than conventional arch repair patients, however, this was noted to be sensitive to results from a particular study. Overall results showed for the hybrid repair cohort, survival at 1, 2, 3, 5 and 7 years was 87%, 85%, 83%, 78% and 75%, respectively. Survival in the conventional repair cohort at 1, 2, 3, 5 and 7 years was 84%, 82%, 80%, 75% and 71%, respectively. Statistically significant findings from meta-analysis showed hybrid arch repair was associated with lower risk of re-operation for bleeding, while conventional arch repair was associated with reduced risk of spinal cord injury.Conclusions: Pooled Kaplan-Meier analysis of all studies showed long-term survival outcomes for hybrid and conventional aortic arch repair patients are heterogeneous and sensitive to the results of particular studies. Superior results from particular centres and the low number of comparative studies mean that more data is required to make definitive findings with regards to the long-term survival outcomes of either procedure. Hybrid arch repair was associated with lower risk of re-operation for bleeding, while conventional arch repair was associated with lower risk of spinal cord injury. Surgeons should consider their own center's experience and patient suitability when deciding between hybrid or conventional aortic repair techniques.

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Section: Introductionmentioning

confidence: 99%

Long-term survival and related outcomes for hybrid versus traditional arch repair—a meta-analysis

Chakos¹,

Jbara²,

Yan³

et al. 2018

Ann. Cardiothorac. Surg.

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“…The operative time for TEVAR with ISLF was 252.2 AE 50 min (range: 182-400) with a mean contrast volume of 203.9 AE 37.5 ml (range: 150-300). The length of stay was 7.2 AE 2.1 days (range: [5][6][7][8][9][10][11][12][13][14]. A patient with brachial artery access suffered hematoma and underwent incision repair at the puncture site.…”

Section: Early Resultsmentioning

confidence: 99%

“…The traditional treatment of open total aortic arch replacement is a highly complex procedure that carries a substantial risk of morbidity and mortality . Although novel endovascular techniques that use fenestrations, branches, and parallel stent grafts to incorporate the branches of the aortic arch were recently developed , the application of endovascular repair of the aortic arch remains challenging because it involves one or more aortic arch vessels and appropriate devices are not yet available.…”

Section: Introductionmentioning

confidence: 99%

Endovascular repair of aortic arch intramural hematoma and penetrating ulcers with 810 nm in situ laser‐assisted fenestration: Preliminary results of a single‐center

et al. 2018

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Purpose The aim of the present study was to report the clinical outcomes of the use of 810 nm in situ laser‐generated fenestration (ISLF) for the treatment of aortic aneurysms (AAs) and intramural hematomas (IMHs) located in the aortic arch. Study Design and Methods Between April 2014 and September 2017, 23 patients (15 men, mean age 66.0 years) with AAs (n = 12) or IMHs (n = 11) underwent thoracic endovascular aortic repair (TEVAR) with 810 nm ISLF of the arch. The primary outcomes of the safety assessment were the presence of endoleaks, mortality and morbidity, including adverse in situ fenestration‐related, cardiovascular, and cerebral events. Results Technical success was achieved in all cases. Urgent intervention was performed in 15 (65.2%) cases. Left subclavian artery (LSA) ISLF was applied in six patients, LSA and left common carotid artery (LCCA) ISLF in three patients, and total aortic arch vessel ISLF in two patients. One patient suffered minimal stroke after the procedure and recovered without permanent disability to the extremities in 2 weeks. There were no fenestration‐related complications except in one patient with brachial artery access who suffered a hematoma and underwent incision repair at the puncture site. All fenestrations remained patent, and there were no endoleaks during a mean follow‐up of 10.5 ± 5.7 (range: 2–21) months. Conclusions Complete or incomplete endovascular arch reconstruction by ISLF in arch diseases (AAs and IMHs) is feasible and reproducible with safe, effective, and favorable primary results and no need for customized endografts. Lasers Surg. Med. 50:837–843, 2018. © 2018 Wiley Periodicals, Inc.

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“…Would arch vessel reconstruction correlate to development of neurologic dysfunction during the reconstruction? A history of neurologic events, 22 older age, 23 or urgency 24 has been shown to be a significant risk factor for intraoperative neurologic events under SCP. However, a multicenter study investigating brain protection using SCP demonstrated that the duration of cerebral perfusion had no impact on neurologic outcome.…”

Section: Discussionmentioning

confidence: 99%

Total arch repair with frozen elephant trunk using the “zone 0 arch repair” strategy for type A acute aortic dissection

Yamamoto¹,

Kadohama²,

Yamaura³

et al. 2020

The Journal of Thoracic and Cardiovascular Surgery

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Open Surgical Repair Remains the Gold Standard for Treating Aortic Arch Pathology

Abstract: These results set a standard against which endovascular technology needs to be compared.

Cited by 37 publications

References 20 publications

Long-term survival and related outcomes for hybrid versus traditional arch repair—a meta-analysis

Long-term survival and related outcomes for hybrid versus traditional arch repair—a meta-analysis

Endovascular repair of aortic arch intramural hematoma and penetrating ulcers with 810 nm in situ laser‐assisted fenestration: Preliminary results of a single‐center

Total arch repair with frozen elephant trunk using the “zone 0 arch repair” strategy for type A acute aortic dissection

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