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Sobhi M, Mohamed BH, Imtinène BM, Rim M, Taoufik K, Melek BM, Ihsène Z, Raouf D. [Hybrid repair of aortic arch aneurysm]. Ann Cardiol Angeiol (Paris) 2021; 70:196-198. [PMID: 34517974 DOI: 10.1016/j.ancard.2021.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Accepted: 07/01/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND The management of aortic arch aneurysms is challenging. If conventional surgery cannot be performed in high risk patients, endovascular treatment is confronted to the problem of endoleaks at long term. However, the hybrid repair combining a first surgical step and a second endovascular step is a new technique recently introduced in the therapeutic alternatives of aortic arch aneurysm but its long-term results are not well known. METHODS We report a series of four patients who received hybrid treatment for aortic arch aneurysms in our department between 2016 and 2018. RESULTS These were 3 men and 1 woman with an average age of 63 years [55-80 years]. All were hypertensive and only one patient had diabetes. The aneurysm was symptomatic of chest pain in all cases and it was ruptured in only one case. Preoperatively, the hemodynamic state was stable in the four patients with a mean aneurysm diameter of 60 mm [48-79 mm] on CT angiography and the landing zone was zone 0 in all cases. Under general anesthesia, the 1st step was surgical with the performance of an aorto-bicarotid bypass associated with a re-implantation of the left subclavian artery and a disconnection of the supraortic trunks. The 2nd stage was endovascular by the femoral route; with release of an aortic stent graft covering the ostia of all supraortic trunks. The final angiographic check-up showed complete exclusion of the aneurysm in all cases. The immediate postoperative follow-up was straightforward except for the onset of septic shock and death in a patient with an aneurysm ruptured in the left pulmonary branch initially. The mean follow-up was 12 months with a CT scan control which confirms the complete exclusion of the aneurysm and the absence of endoleak.
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Affiliation(s)
- Mleyhi Sobhi
- University of Tunis El Manar, Faculty of Medicine of Tunis, La Rabta Hospital, Cardiovascular surgery Department, Tunis, Tunisia.
| | - Ben Hammamia Mohamed
- University of Tunis El Manar, Faculty of Medicine of Tunis, La Rabta Hospital, Cardiovascular surgery Department, Tunis, Tunisia
| | - Ben Mrad Imtinène
- University of Tunis El Manar, Faculty of Medicine of Tunis, HabibThameur Hospital, Cardiology Department, Tunis, Tunisia
| | - Miri Rim
- University of Tunis El Manar, Faculty of Medicine of Tunis, La Rabta Hospital, Cardiovascular surgery Department, Tunis, Tunisia
| | - Kalfat Taoufik
- University of Tunis El Manar, Faculty of Medicine of Tunis, La Rabta Hospital, Cardiovascular surgery Department, Tunis, Tunisia
| | - Ben Mrad Melek
- University of Tunis El Manar, Faculty of Medicine of Tunis, HabibThameur Hospital, Cardiology Department, Tunis, Tunisia
| | - Zairi Ihsène
- University of Tunis El Manar, Faculty of Medicine of Tunis, HabibThameur Hospital, Cardiology Department, Tunis, Tunisia
| | - Denguir Raouf
- University of Tunis El Manar, Faculty of Medicine of Tunis, La Rabta Hospital, Cardiovascular surgery Department, Tunis, Tunisia
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Zlatanovic P, Koncar I, Sladojevic M, Tomic I, Mutavdzic P, Trailovic R, Ducic S, Vujcic A, Davidovic L. Hybrid repair of aortic arch with zone zero endografting-Case series with review of the literature. J Card Surg 2021; 36:3805-3816. [PMID: 34268799 DOI: 10.1111/jocs.15811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 06/14/2021] [Accepted: 06/16/2021] [Indexed: 11/26/2022]
Abstract
INTRODUCTION We present single-institution results of types I and II hybrid procedures for aortic arch disease with 30-day and long-term results and review of the literature. MATERIALS AND METHODS This is a retrospective study of all patients that underwent zone 0 endografting and open bypass from ascending aorta to the arch vessels at our institution between January 2013 and 2020. The following data for the systematic review were extracted from eligible studies: 30-day/in-hospital mortality, stroke rate, spinal cord ischemia (SCI) rate, renal failure requiring dialysis, development of retrograde dissection, early (<30 days) types I and III endoleak, follow-up length, late (>30 days) endoleak, and late (>30 days) mortality. RESULTS Twelve patients underwent hybrid aortic arch treatment in our institution. The most common aortic arch pathology was degenerative aortic aneurysm. The rate of retrograde dissection and SCI was 8.33%. Regarding the literature data, a total of 768 patients undergoing types I and II hybrid aortic arch debranching procedure. The pooled rate of 30-day/in-hospital mortality was 10.96% (95% confidence interval [CI], 8.21-14.06), SCI pooled rate was 2.91% (95% CI, 1.76%-4.33%), and retrograde dissection pooled rate was 3.22% (95% CI, 1.99-4.72). CONCLUSION Hybrid arch techniques provide safe alternative to open repair with acceptable short- and midterm results.
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Affiliation(s)
- Petar Zlatanovic
- Clinic for Vascular and Endovascular Surgery, Clinical Center of Serbia, Belgrade, Serbia
| | - Igor Koncar
- Clinic for Vascular and Endovascular Surgery, Clinical Center of Serbia, Belgrade, Serbia.,School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Milos Sladojevic
- Clinic for Vascular and Endovascular Surgery, Clinical Center of Serbia, Belgrade, Serbia.,School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Ivan Tomic
- Clinic for Vascular and Endovascular Surgery, Clinical Center of Serbia, Belgrade, Serbia.,School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Perica Mutavdzic
- Clinic for Vascular and Endovascular Surgery, Clinical Center of Serbia, Belgrade, Serbia.,School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Ranko Trailovic
- Clinic for Vascular and Endovascular Surgery, Clinical Center of Serbia, Belgrade, Serbia.,School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Stefan Ducic
- Clinic for Vascular and Endovascular Surgery, Clinical Center of Serbia, Belgrade, Serbia
| | - Aleksandra Vujcic
- Clinic for Vascular and Endovascular Surgery, Clinical Center of Serbia, Belgrade, Serbia
| | - Lazar Davidovic
- Clinic for Vascular and Endovascular Surgery, Clinical Center of Serbia, Belgrade, Serbia.,School of Medicine, University of Belgrade, Belgrade, Serbia
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Qi RD, Zhu JM, Liu YM, Chen L, Li CN, Xing XY, Zhang N, Sun LZ. Distal Arch Aneurysm Repair Using Left Subclavian Artery Transposition With Stented Elephant Trunk in the Hybrid Repair Era. Heart Lung Circ 2019; 28:814-819. [DOI: 10.1016/j.hlc.2018.03.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Revised: 02/07/2018] [Accepted: 03/12/2018] [Indexed: 10/17/2022]
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Ben Hammamia M, Ziadi J, Miri R, Ben Mrad M, Ghedira F, Denguir R. Hybrid Repair of a Saccular Aortic Arch Aneurysm Ruptured in the Left Pulmonary Bronchus. Ann Vasc Surg 2019; 57:272.e9-272.e13. [PMID: 30684627 DOI: 10.1016/j.avsg.2018.09.040] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Revised: 09/25/2018] [Accepted: 09/27/2018] [Indexed: 11/26/2022]
Abstract
The rupture of aortic arch aneurysm is rare but serious and a life-threatening pathologic condition. We report a case of an 80-year-old woman who was admitted to our department for a rupture of a saccular aortic arch aneurysm in the left pulmonary bronchus. There was no landing zone in the aortic arch. First, we performed a total supra-aortic debranching and a bifurcated graft bypass from the ascending aorta to both the innominate artery and the left carotid artery. Then, we implanted in the aortic arch an endoprosthesis covering the origin of all supra-aortic trunks. Final angiography was satisfactory. The patient died 8 days later due to pulmonary-originated septic shock. Aortic arch hybrid procedures show a variety of severe complications associated with a relevant morbidity, mortality, and reintervention rate. Prognosis of rupture depends not only on the hemorrhage caused but also on the potential infection.
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Affiliation(s)
- Mohamed Ben Hammamia
- Cardiovascular department La Rabta, Tunis Faculty of medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia.
| | - Jalel Ziadi
- Cardiovascular department La Rabta, Tunis Faculty of medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Rim Miri
- Cardiovascular department La Rabta, Tunis Faculty of medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Malek Ben Mrad
- Cardiovascular department La Rabta, Tunis Faculty of medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Faker Ghedira
- Cardiovascular department La Rabta, Tunis Faculty of medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Raouf Denguir
- Cardiovascular department La Rabta, Tunis Faculty of medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
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Gokalp O, Yesilkaya N, Besir Y, Yilik L, Iner H, Gokalp G, Gurbuz A. Re: 'Comparison of Total Arch and Partial Arch Transposition During Hybrid Endovascular Repair for Aortic Arch Disease'. Eur J Vasc Endovasc Surg 2016; 52:703. [PMID: 27614552 DOI: 10.1016/j.ejvs.2016.07.092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2016] [Accepted: 07/10/2016] [Indexed: 11/29/2022]
Affiliation(s)
- O Gokalp
- Izmir Katip Celebi University, Faculty of Medicine, Department of Cardiovascular Surgery, Izmir, Turkey.
| | - N Yesilkaya
- Izmir Ataturk Education and Research Hospital, Department of Cardiovascular Surgery, Izmir, Turkey
| | - Y Besir
- Izmir Katip Celebi University, Faculty of Medicine, Department of Cardiovascular Surgery, Izmir, Turkey
| | - L Yilik
- Izmir Katip Celebi University, Faculty of Medicine, Department of Cardiovascular Surgery, Izmir, Turkey
| | - H Iner
- Izmir Ataturk Education and Research Hospital, Department of Cardiovascular Surgery, Izmir, Turkey
| | - G Gokalp
- Tepecik Education and Research Hospital, Department of Pediatric Emergency, Izmir, Turkey
| | - A Gurbuz
- Izmir Katip Celebi University, Faculty of Medicine, Department of Cardiovascular Surgery, Izmir, Turkey
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