Results of type II hybrid arch repair with zone 0 stent graft deployment for complex aortic arch pathology.
Publication/Presentation Date
12-1-2014
Abstract
OBJECTIVE: To review the early results of a less invasive, single-stage hybrid arch procedure involving replacement of the ascending aorta, arch debranching, and zone 0 antegrade stent graft deployment.
METHODS: Between May 2007 and January 2012, 20 patients with both acute and chronic aortic pathology were managed at 2 institutions with a type 2 hybrid arch procedure. Indications included diffuse atherosclerotic aneurysm, false lumen expansion of chronic aortic dissections, penetrating atherosclerotic ulcer, and acute type A dissection. Mean age was 67 ± 16.8 years with a mean European System for Cardiac Operative Risk Evaluation II score of 29.5 ± 19.4. Postoperative clinical and imaging follow-up was complete to a mean 18.5 ± 15.3 months.
RESULTS: Successful zone 0 stent graft deployment was achieved in all cases. There was 1 in-hospital mortality (5%). A second death occurred at 40 days postoperation. Other complications included a permanent neurologic deficit in 1 patient (5%), transient paraplegia in 4 patients (20%), and 3 patients had respiratory complications (15%). There were no cases of renal failure requiring dialysis. Stent-related complications were identified in 4 patients (20%), including 3 type I endoleaks, none of which were at zone 0. There was 1 type II endoleak and a case of stent infolding. Two patients required a second successful endografting procedure.
CONCLUSIONS: This single-stage hybrid arch procedure offers an alternative approach to complex diffuse aortic pathology involving the arch. Replacement of the ascending aorta provides a safe location for zone 0 stent graft deployment, eliminating complications of proximal deployment in a native diseased aorta.
Volume
148
Issue
6
First Page
2951
Last Page
2955
ISSN
1097-685X
Published In/Presented At
Kent, W. D., Appoo, J. J., Bavaria, J. E., Herget, E. J., Moeller, P., Pochettino, A., & Wong, J. K. (2014). Results of type II hybrid arch repair with zone 0 stent graft deployment for complex aortic arch pathology. The Journal of thoracic and cardiovascular surgery, 148(6), 2951–2955. https://doi.org/10.1016/j.jtcvs.2014.06.070
Disciplines
Medicine and Health Sciences
PubMedID
25125209
Department(s)
Department of Surgery
Document Type
Article