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Lodo V, Centofanti P. Current techniques of repair of aortic arch pathologies and the role of the aortic team. Indian J Thorac Cardiovasc Surg 2024; 40:451-460. [PMID: 38919191 PMCID: PMC11194227 DOI: 10.1007/s12055-024-01704-x] [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: 12/04/2023] [Revised: 02/05/2024] [Accepted: 02/06/2024] [Indexed: 06/27/2024] Open
Abstract
The treatment of aortic arch pathologies is becoming progressively more complex and multidisciplinary. Despite progresses in open surgical techniques, the high rate of surgical morbidity and mortality, especially in frail and elderly patients, has led to the development of alternative treatment options to conventional open surgery such as hybrid and endovascular procedures. Our purpose is to summarize the advantages and disadvantages of the different approaches and investigate the role of a dedicated aortic team in the choice of the most appropriate treatment for each patient.
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Affiliation(s)
- Vittoria Lodo
- Division of Cardiac Surgery, Azienda Ospedaliera Ordine Mauriziano Di Torino, Largo Filippo Turati 6, 10128 Turin, Italy
| | - Paolo Centofanti
- Division of Cardiac Surgery, Azienda Ospedaliera Ordine Mauriziano Di Torino, Largo Filippo Turati 6, 10128 Turin, Italy
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Chen CW, Hu J, Li YY, Chen GX, Zhang W, Chen XY. The outcomes of aortic arch repair between open surgical repair and debranching endovascular hybrid surgical repair: A systematic review and meta-analysis. J Vasc Surg 2024; 79:1510-1524. [PMID: 38122857 DOI: 10.1016/j.jvs.2023.12.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 11/26/2023] [Accepted: 12/10/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND At present, open surgical aortic arch repair (OAR) and debranching hybrid surgical aortic arch repair (HAR) serve as significant therapeutic approaches for aortic arch aneurysm or dissection. It remains unclear which technique is preferable. Our study aimed to compare the short-term and long-term outcomes of these two procedures. METHODS To identify comparison studies of debranching HAR and OAR, a systematic search of the PubMed, Embase, Web of Science, and Cochrane Library databases was performed from January 2002 to April 2022. This study was registered on PROSPERO (CRD42020218080). RESULTS Sixteen publications (1316 patients), including six propensity score-matching (PSM) analysis papers, were included in this study. Compared with the HAR group, the patients who underwent OAR were younger (OAR vs HAR: 67.53 ± 12.81 vs 71.29 ± 11.0; P < .00001), had less coronary artery disease (OAR vs HAR: 22.45% vs 32.6%; P = .007), less chronic obstructive pulmonary disease (OAR vs HAR: 16.16% vs 23.92%; P = .001), lower rates of previous stroke (OAR vs HAR: 12.46% vs 18.02%; P = .05), and a lower EuroSCORE (European System for Cardiac Operative Risk Evaluation) score (OAR vs HAR: 6.27 ± 1.04 vs 6.9 ± 3.76; P < .00001). HAR was associated with less postoperative blood transfusion (OAR vs HAR: 12.23% vs 7.91%; P = .04), shorter length of intensive care unit stays (OAR vs HAR: 5.92 ± 7.58 days vs 4.02 ± 6.60 days; P < .00001) and hospital stays (OAR vs HAR: 21.59 ± 17.54 days vs 16.49 ± 18.45 days; P < .0001), lower incidence of reoperation for bleeding complications (OAR vs HAR: 8.07% vs 3.96%; P = .01), fewer postoperative pulmonary complication (OAR vs HAR: 14.75% vs 5.02%; P < .0001), and acute renal failure (OAR vs HAR: 7.54% vs 5.17%; P = .03). In the PSM subgroup, the rates of spinal cord ischemic (OAR vs HAR: 5.75% vs 11.49%; P = .02), stroke (OAR vs HAR: 5.1% vs 17.35%; P = .01), and permanent paraplegia (OAR vs HAR: 2.79% vs 6.08%; P = .006) were lower in the OAR group than that in the HAR group. Although there was no statistically significant difference in 1-year survival rates (HAR vs OAR: hazard ratio [HR]: 1.54; P = .10), the 3-year and 5-year survivals were significantly higher in the OAR group than that in the HAR group (HAR vs OAR: HR: 1.69; P = .01; HAR vs OAR: HR: 1.68; P = .01). In the PSM subgroup, the OAR group was also significantly superior to the HAR group in terms of 3-year and 5-year survivals (HAR vs OAR: HR: 1.73; P = .04; HAR vs OAR: HR: 1.67; P = .04). The reintervention rate in the HAR group was significantly higher than that in the OAR group (OAR vs HAR: 8.24% vs 16.01%; P = .01). The most common reintervention was postoperative bleeding (8.07%) in the OAR group and endoleak (9.67%) in the HAR group. CONCLUSIONS Our meta-analysis revealed that debranching HAR was associated with fewer perioperative complications than the OAR group, except for postoperative permanent paraplegia, reintervention, and stroke events. The OAR group demonstrated better 3-year and 5-year survivals than the debranching HAR group. However, patients in the OAR group had fewer comorbid factors and were younger than those in the HAR group. High-quality studies and well-powered randomized trials are needed to further evaluate this evolving field.
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Affiliation(s)
- Chu Wen Chen
- Division of Liver Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Jing Hu
- Division of Health Management Centre, West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Yi Yuan Li
- Division of Vascular Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Guo Xing Chen
- Division of Vascular Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Wayne Zhang
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Washington and Puget Sound VA Health Care System, Seattle, WA
| | - Xi Yang Chen
- Division of Vascular Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu, China.
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Wang C, Li W, Yang P, Lu C, Zhang Y, Wang H, Xiao Z, Hu J. Double-branched stent graft and four-stage deployment in total arch repair: safety and feasibility evaluation in porcine models. INTERDISCIPLINARY CARDIOVASCULAR AND THORACIC SURGERY 2024; 38:ivae049. [PMID: 38492560 PMCID: PMC11014789 DOI: 10.1093/icvts/ivae049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 01/12/2024] [Accepted: 03/14/2024] [Indexed: 03/18/2024]
Abstract
OBJECTIVES The primary objective of this research was to evaluate the safety and feasibility of an innovative double-branched stent graft system employing four-stage deployment technology for aortic arch repair in porcine models. METHODS The double-branched stent graft system consisted of a proximal polyester artificial blood vessel, the main and double-branched stent grafts and a delivery system. We utilized 12 healthy pigs as experimental animals (6 per group). Postimplantation, samples were collected at 90 and 180 days after the operations. Preoperative and postoperative imaging and intraoperative arterial blood gas analyses were performed. After the pigs were euthanized, the implanted product, surrounding tissue and major organs were collected for pathological analysis. RESULTS The technical success rate of the stent graft implants was 100% (12/12). All animals survived to the experimental end point. Perioperative assessments showed intact stent grafts, and imaging features at the end of the follow-up period revealed neither endoleak nor device migration. No major adverse cardiovascular events were observed during the postoperative follow-up period. Pathological examinations confirmed the satisfactory biocompatibility of the stent graft. CONCLUSIONS This innovative double-branched stent graft system with four-stage deployment technology was affirmed as a safe and feasible option for aortic arch repair in accordance with our preclinical evaluation with porcine models.
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Affiliation(s)
- Chenhao Wang
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province, P.R. China
| | - Wenfan Li
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province, P.R. China
| | - Peng Yang
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province, P.R. China
| | - Chen Lu
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province, P.R. China
| | - Yu Zhang
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province, P.R. China
| | - Haiyue Wang
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province, P.R. China
| | - Zhenghua Xiao
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province, P.R. China
| | - Jia Hu
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province, P.R. China
- Department of Cardiothoracic Surgery, West China Guang’an Hospital, Sichuan University, Guang’an, Sichuan Province, P.R. China
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Ogino H, Iida O, Akutsu K, Chiba Y, Hayashi H, Ishibashi-Ueda H, Kaji S, Kato M, Komori K, Matsuda H, Minatoya K, Morisaki H, Ohki T, Saiki Y, Shigematsu K, Shiiya N, Shimizu H, Azuma N, Higami H, Ichihashi S, Iwahashi T, Kamiya K, Katsumata T, Kawaharada N, Kinoshita Y, Matsumoto T, Miyamoto S, Morisaki T, Morota T, Nanto K, Nishibe T, Okada K, Orihashi K, Tazaki J, Toma M, Tsukube T, Uchida K, Ueda T, Usui A, Yamanaka K, Yamauchi H, Yoshioka K, Kimura T, Miyata T, Okita Y, Ono M, Ueda Y. JCS/JSCVS/JATS/JSVS 2020 Guideline on Diagnosis and Treatment of Aortic Aneurysm and Aortic Dissection. Circ J 2023; 87:1410-1621. [PMID: 37661428 DOI: 10.1253/circj.cj-22-0794] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/05/2023]
Affiliation(s)
- Hitoshi Ogino
- Department of Cardiovascular Surgery, Tokyo Medical University
| | - Osamu Iida
- Cardiovascular Center, Kansai Rosai Hospital
| | - Koichi Akutsu
- Cardiovascular Medicine, Nippon Medical School Hospital
| | - Yoshiro Chiba
- Department of Cardiology, Mito Saiseikai General Hospital
| | | | | | - Shuichiro Kaji
- Department of Cardiovascular Medicine, Kansai Electric Power Hospital
| | - Masaaki Kato
- Department of Cardiovascular Surgery, Morinomiya Hospital
| | - Kimihiro Komori
- Division of Vascular and Endovascular Surgery, Department of Surgery, Nagoya University Graduate School of Medicine
| | - Hitoshi Matsuda
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center
| | - Kenji Minatoya
- Department of Cardiovascular Surgery, Graduate School of Medicine, Kyoto University
| | | | - Takao Ohki
- Division of Vascular Surgery, Department of Surgery, The Jikei University School of Medicine
| | - Yoshikatsu Saiki
- Division of Cardiovascular Surgery, Graduate School of Medicine, Tohoku University
| | - Kunihiro Shigematsu
- Department of Vascular Surgery, International University of Health and Welfare Mita Hospital
| | - Norihiko Shiiya
- First Department of Surgery, Hamamatsu University School of Medicine
| | | | - Nobuyoshi Azuma
- Department of Vascular Surgery, Asahikawa Medical University
| | - Hirooki Higami
- Department of Cardiology, Japanese Red Cross Otsu Hospital
| | | | - Toru Iwahashi
- Department of Cardiovascular Surgery, Tokyo Medical University
| | - Kentaro Kamiya
- Department of Cardiovascular Surgery, Tokyo Medical University
| | - Takahiro Katsumata
- Department of Thoracic and Cardiovascular Surgery, Osaka Medical College
| | - Nobuyoshi Kawaharada
- Department of Cardiovascular Surgery, Sapporo Medical University School of Medicine
| | | | - Takuya Matsumoto
- Department of Vascular Surgery, International University of Health and Welfare
| | | | - Takayuki Morisaki
- Department of General Medicine, IMSUT Hospital, the Institute of Medical Science, the University of Tokyo
| | - Tetsuro Morota
- Department of Cardiovascular Surgery, Nippon Medical School Hospital
| | | | - Toshiya Nishibe
- Department of Cardiovascular Surgery, Tokyo Medical University
| | - Kenji Okada
- Department of Surgery, Division of Cardiovascular Surgery, Kobe University Graduate School of Medicine
| | | | - Junichi Tazaki
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
| | - Masanao Toma
- Department of Cardiology, Hyogo Prefectural Amagasaki General Medical Center
| | - Takuro Tsukube
- Department of Cardiovascular Surgery, Japanese Red Cross Kobe Hospital
| | - Keiji Uchida
- Cardiovascular Center, Yokohama City University Medical Center
| | - Tatsuo Ueda
- Department of Radiology, Nippon Medical School
| | - Akihiko Usui
- Department of Cardiac Surgery, Nagoya University Graduate School of Medicine
| | - Kazuo Yamanaka
- Cardiovascular Center, Nara Prefecture General Medical Center
| | - Haruo Yamauchi
- Department of Cardiac Surgery, The University of Tokyo Hospital
| | | | - Takeshi Kimura
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
| | | | - Yutaka Okita
- Department of Surgery, Division of Cardiovascular Surgery, Kobe University Graduate School of Medicine
| | - Minoru Ono
- Department of Cardiac Surgery, Graduate School of Medicine, The University of Tokyo
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Kudo T, Kuratani T, Sawa Y, Miyagawa S. Assessment of the Effectiveness of Zone 1-Landing Hybrid TEVAR by Comparing Its Outcomes with Those of Zone 2-Landing Hybrid TEVAR. J Clin Med 2023; 12:5326. [PMID: 37629368 PMCID: PMC10455504 DOI: 10.3390/jcm12165326] [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: 07/05/2023] [Revised: 08/09/2023] [Accepted: 08/14/2023] [Indexed: 08/27/2023] Open
Abstract
Background: Hybrid thoracic endovascular aortic repair (TEVAR) without median sternotomy is increasingly being performed in high-risk patients with aortic arch disease. The outcomes of hybrid TEVAR were reported to be worse with a more proximal landing zone. This study aims to clarify the effectiveness of zone 1-landing hybrid TEVAR by comparing the outcomes of zone 2-landing hybrid TEVAR. Methods: From April 2008 to October 2020, 213 patients (zone 1: zone 1-landing hybrid TEVAR, n = 82, 38.5%; zone 2: zone 2-landing hybrid TEVAR, n = 131, 61.5%) were enrolled (median age, 72 years; interquartile range [IQR], 65-78 years), with a median follow-up period of 6.0 years (IQR, 2.8-9.7 years). Results: The mean logistic EuroSCORE was 20.9 ± 14.8%: the logistic EuroSCORE of the zone 1 group (23.3 ± 16.1) was significantly higher than that of the zone 2 group (19.3 ± 12.4%, p = 0.045). The operative time and hospital stay of the zone 1 group were significantly longer than those of the zone 2 group. On the other hand, the in-hospital and late outcomes did not differ significantly between the two groups. There were no significant differences in cumulative survival (66.8% vs. 78.0% at 10 years, Log-rank p = 0.074), aorta-related death-free rates (97.6% vs. 99.2% at 10 years, Log-rank p = 0.312), and aortic event-free rates (81.4% vs. 87.9% at 10 years, Log-rank p = 0.257). Conclusions: Zone 1- and 2-landing hybrid TEVAR outcomes were satisfactory. Despite the high procedural difficulty and surgical risk, the outcomes of zone 1-landing hybrid TEVAR were equal to those of zone 2-landing hybrid TEVAR. If the surgical risk is high, zone 1-landing hybrid TEVAR should not be avoided.
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Affiliation(s)
- Tomoaki Kudo
- Department of Cardiovascular Surgery, Graduate School of Medicine, Osaka University, Suita 565-0871, Osaka, Japan
| | - Toru Kuratani
- Department of Minimally Invasive Cardiovascular Medicine, Graduate School of Medicine, Osaka University, Suita 565-0871, Osaka, Japan
| | - Yoshiki Sawa
- Department of Cardiovascular Surgery, Graduate School of Medicine, Osaka University, Suita 565-0871, Osaka, Japan
| | - Shigeru Miyagawa
- Department of Cardiovascular Surgery, Graduate School of Medicine, Osaka University, Suita 565-0871, Osaka, Japan
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Li W, Li Q, Li J, Cui M, Xu R, Zhai S, Li T, Chen J, Zhao W. Complete Endovascular Reconstruction of the Canine Ascending Aorta, Aortic Arch, and Supra-Aortic Vessels by Implanting a New Unibody Outer Double-Branched Stent-Graft. J Endovasc Ther 2022:15266028221139194. [PMID: 36444636 DOI: 10.1177/15266028221139194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024]
Abstract
PURPOSE We evaluated the feasibility and safety of using a new unibody outer double-branched stent-graft system to reconstruct the canine ascending aorta, aortic arch, and supra-aortic vessels. MATERIALS AND METHODS The outer-branched stent-graft was a unibody design. The branched stent-graft consisted of a main stent-graft and 2 branches. The introducer system included a tri-channel catheter, 2 detachable sleeves, a front fixing device, a constraining wire, and a curved outer sheath. The branched stent-graft was loaded into the introducer system. Ten adult mongrel dogs underwent general anesthesia, and the branched stent-grafts were deployed into the canine ascending aorta, aortic arch, and supra-aortic vessels by the introducer system. All animals were followed up for 3 months. At the end of the follow-up period, computed tomographic angiography (CTA) was performed to observe the patency of the branched stent-grafts. RESULTS The mean operation time was 142.7±13.7 minutes. The mean fluoroscopy time was 20.73±2.22 minutes. The mean dosage of contrast agent was 95.9±8.7 mL. During the operation, the tri-channel catheters successfully paralleled the wires in the aorta. All 10 branched stent-grafts were successfully implanted into the canine ascending aorta and aortic arch. There were no symptoms of cerebral embolization and no incision infection during the follow-up period. Computed tomographic angiography and specimens showed that the branched stent-grafts and native vessels were patent, the inner surfaces of the branched stent-grafts were covered by neointima, and there was no retrograde aortic dissection in the ascending aorta. CONCLUSIONS This animal research demonstrated that the unibody outer double-branched stent-graft system could be applied to reconstruct the canine ascending aorta, aortic arch, and supra-aortic vessels. CLINICAL IMPACT Thoracic endovascular aortic repair has been the main treatment method for aortic aneurysms or dissections involving the descending thoracic aorta. However, the aortic arch and ascending aorta remain the last segments of the aorta without a validated and routinely used endovascular option. In this research, we designed a new unibody outer branched stent-graft system to reconstruct the distal ascending aorta, aortic arch and supra-aortic vessels. The unibody outer branched stent-graft system could be applied to treat aortic pathologies which involve the middle and distal proximal ascending aorta, aortic arch and proximal descending aorta.
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Affiliation(s)
- Weixiao Li
- Department of Vascular and Endovascular Surgery, Zhengzhou University People's Hospital, Henan Provincial People's Hospital, Zhengzhou, China
| | - Qiang Li
- Department of Medical Imaging, Zhengzhou University People's Hospital, Henan Provincial People's Hospital, Zhengzhou, China
| | - Jun Li
- Department of Operation, Zhengzhou University People's Hospital, Henan Provincial People's Hospital, Zhengzhou, China
| | - Mingzhe Cui
- Department of Vascular and Endovascular Surgery, Zhengzhou University People's Hospital, Henan Provincial People's Hospital, Zhengzhou, China
| | - Rutao Xu
- Department of Vascular and Endovascular Surgery, Zhengzhou University People's Hospital, Henan Provincial People's Hospital, Zhengzhou, China
| | - Shuiting Zhai
- Department of Vascular and Endovascular Surgery, Zhengzhou University People's Hospital, Henan Provincial People's Hospital, Zhengzhou, China
| | - Tianxiao Li
- Department of Cerebrovascular Disease, Zhengzhou University People's Hospital, Henan Provincial People's Hospital, Zhengzhou, China
| | - Jiangbo Chen
- Department of Vascular and Endovascular Surgery, Zhengzhou University People's Hospital, Henan Provincial People's Hospital, Zhengzhou, China
| | - Wenli Zhao
- Department of Operation, Zhengzhou University People's Hospital, Henan Provincial People's Hospital, Zhengzhou, China
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Effectiveness and Minimal-Invasiveness of Zone 0 Landing Thoracic Endovascular Aortic Repair Using Branched Endograft. J Clin Med 2022; 11:jcm11236981. [PMID: 36498553 PMCID: PMC9738699 DOI: 10.3390/jcm11236981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 11/16/2022] [Accepted: 11/24/2022] [Indexed: 11/29/2022] Open
Abstract
Background: Zone 0 landing thoracic endovascular aortic repair (TEVAR) for the treatment of aortic arch diseases has become a topic of interest. This study aimed to verify whether branced TEVAR (bTEVAR) is an effective and a more minimally invasive treatment by comparing the outcomes of bTEVAR and hybrid TEVAR (hTEVAR) in landing zone 0. Methods: This retrospective, single-center, observational cohort study included 54 patients (bTEVAR, n = 25; hTEVAR, n = 29; median age, 78 years; median follow-up period, 5.4 years) from October 2012 to June 2018. The logistic Euro-SCORE was significantly higher in the bTEVAR group than in the hTEVAR group (38% vs. 21%, p < 0.001). Results: There was no significant difference the in-hospital mortality between the bTEVAR and hTEVAR groups (0% vs. 3.4%, p = 1.00). The operative time (220 vs. 279 min, p < 0.001) and length of hospital stay (12 vs. 17 days, p = 0.013) were significantly shorter in the bTEVAR group than in the hTEVAR group. The 7-year free rates of aorta-related deaths (bTEVAR [95.5%] vs. hTEVAR [86.9%], Log-rankp = 0.390) and aortic reintervention (bTEVAR [86.3%] vs. hTEVAR [86.9%], Log-rankp = 0.638) were not significantly different. Conclusions: The early and mid-term outcomes in both groups were satisfactory. bTEVAR might be superior to hTEVAR in that it is less invasive. Therefore, bTEVAR may be considered an effective and a more minimally invasive treatment for high-risk patients.
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Sharaf OM, Kohtz PD, Arnaoutakis GJ. Aortic Arch Repair Using Open and Hybrid Techniques: A Systematic Review. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2022; 17:273-282. [PMID: 35934948 DOI: 10.1177/15569845221115355] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Early surgical intervention is critical for treatment of aortic arch aneurysms and dissections, but limited comprehensive data exist to define the optimal approach for surgical management with respect to postoperative outcomes. We conducted a systematic review of the 2 most common surgical approaches-total arch replacement and hybrid arch repair. We referenced the electronic PubMed database reporting on outcomes for these surgical approaches from inception to June 2022. Our initial search query returned a total of 2,517 records. All records were independently screened for adherence to our inclusion criteria and a total of 12 retrospective cohort studies were identified as appropriate for inclusion. Across the included studies, a total of 618 patients underwent hybrid repair, as compared to 2,104 patients who underwent total arch replacement. We found that most of the literature supported the findings of similar rates of permanent neurologic dysfunction, acute kidney injury, and short-term mortality between approaches and higher postoperative reintervention rates following hybrid repair. Reported outcomes of studies included in this review often conflicted regarding midterm and long-term survival, as well as hospital and intensive care unit length of stay following open and hybrid repair. Future studies should address midterm and long-term survival with a prospective study design.
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Affiliation(s)
- Omar M Sharaf
- College of Medicine, 12233University of Florida, Gainesville, FL, USA
| | - Patrick D Kohtz
- Department of Surgery, Division of Cardiovascular Surgery, 440202University of Florida Health, Gainesville, FL, USA
| | - George J Arnaoutakis
- Department of Surgery, Division of Cardiovascular Surgery, 440202University of Florida Health, Gainesville, FL, USA
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Venkatesan A, Gonuguntla A, Vasireddy A, Rai GD, Kamath GS, Bishnoi AK, Maramreddy R. Asymptomatic Giant Aneurysm of the Arteria Lusoria Treated by Debranching and Aneurysmal Resection. Vasc Specialist Int 2022; 38:3. [PMID: 35307697 PMCID: PMC8938156 DOI: 10.5758/vsi.210069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 01/01/2022] [Accepted: 02/27/2022] [Indexed: 11/30/2022] Open
Abstract
The aberrant right subclavian artery (ARSA, arteria lusoria) is the most common intrathoracic vascular anomaly, affecting up to 2% of the population. However, aneurysms of congenital anomalies are extremely unusual and often present with dysphagia, dysphonia, or dyspnea due to compression of the surrounding structures. We report a case of an asymptomatic 57-year-old male with chronic kidney disease who was incidentally found to have a large aneurysm of the ARSA on preoperative computed tomography for laparoscopic nephrectomy. Surgery is unequivocally warranted as these aneurysms are associated with a high risk of complications, including thrombosis, embolism, and rupture. We debranched the ARSA, followed by anastomosis to the right carotid artery through a right neck incision. Subsequently, aneurysmal resection was performed through left thoracotomy. The patient had an uneventful postoperative recovery and was asymptomatic during the follow-up.
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Affiliation(s)
- Aadithiyavikram Venkatesan
- Department of Cardiovascular and Thoracic Surgery, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India
| | - Akhilesh Gonuguntla
- Department of Cardiovascular and Thoracic Surgery, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India
| | - Anila Vasireddy
- Department of Cardiovascular and Thoracic Surgery, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India
| | - Guruprasad D Rai
- Department of Cardiovascular and Thoracic Surgery, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India
| | - Ganesh Sevagur Kamath
- Department of Cardiovascular and Thoracic Surgery, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India
| | - Arvind Kumar Bishnoi
- Department of Cardiovascular and Thoracic Surgery, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India
| | - Revanth Maramreddy
- Department of Cardiovascular and Thoracic Surgery, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India
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Liu S, Qiu J, Qiu J, Jiang W, Gao W, Wei B, Yu C. Midterm Outcomes of One-Stage Hybrid Aortic Arch Repair for Stanford Type A Aortic Dissection: A Single Center's Experience. Semin Thorac Cardiovasc Surg 2022; 35:311-321. [PMID: 35276357 DOI: 10.1053/j.semtcvs.2021.12.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 12/02/2021] [Indexed: 11/11/2022]
Abstract
This study sought to identify the midterm outcomes of one-stage hybrid aortic arch repair (HAAR) in patients with Stanford type A aortic dissection (TAAD). Between January 2010 and December 2015, 75 consecutive patients with TAAD involving the aortic arch who underwent one-stage type Ⅱ HAAR at our institution were identified. During this period, 496 consecutive patients with TAAD underwent traditional total aortic arch replacement (TAR) with frozen elephant trunk. The preoperative, perioperative and postoperative data of all patients were compared. A propensity score-matching analysis was applied to adjust for baseline risk factors. 571 patients were included for analysis (428 men; mean age, 48.9±11.1 years). For all patients, the mean follow-up time was 41.1±22.1 months, in-hospital mortality was 4.7% and the 5-year survival rate was 89.5%. Midterm outcomes between the propensity-matched groups were compared (59 HAAR vs TAR pairs). HAAR group showed shorter cardiopulmonary bypass time (105-159 min vs 158-230 min, p < 0.001), aortic cross-clamping time, postoperative ventilation time and intensive care unit stays (33-108 h vs 45-131 h, p = 0.010) than the TAR group. There were no significant differences in in-hospital mortality, rate of stroke and rate of paraplegia between the two groups, however, better 5-year survival rate was found in HAAR group (94.9% vs 75.8%, Log-rank p = 0.005). As compared to propensity matched cohort of TAR patients, HAAR shows good midterm outcomes for patients with TAAD. Further randomized study was needed to clarify the optimal management strategy of TAAD.
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Affiliation(s)
- Shen Liu
- Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, PR China; Department of Cardiovascular Surgery, Peking University International Hospital, Peking University Health Science Center, Beijing, PR China
| | - Jiawei Qiu
- Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, PR China
| | - Juntao Qiu
- Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, PR China
| | - Wenxiang Jiang
- Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, PR China
| | - Wei Gao
- Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, PR China
| | - Bo Wei
- Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, PR China
| | - Cuntao Yu
- Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, PR China.
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11
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Boroumand S, Ahmadi-Tafti SH, Davoodi S, Forouzannia SK. Late Retrograde Aortic Dissection after Hybrid Thoracic Endovascular Aortic Repair (TEVAR): A Case Report. J Tehran Heart Cent 2022; 16:38-41. [PMID: 35082867 PMCID: PMC8728859 DOI: 10.18502/jthc.v16i1.6601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 10/18/2020] [Indexed: 11/24/2022] Open
Abstract
Open total arch replacement is allied to high rates of mortality and morbidity; surgeons, therefore, tend to choose hybrid aortic arch repair as a less invasive operative procedure for the treatment of aortic arch aneurysms, especially in high-risk patients. However, studies on the early and late outcomes of patients undergoing hybrid aortic arch repair have revealed high rates of reintervention and reoperation compared with open total arch replacement. Here, we describe a male patient with late retrograde aortic dissection after hybrid thoracic endovascular aortic repair for aortic arch aneurysms. The patient returned 3 years after the procedure with signs of dyspnea on exertion and chest pain. Transthoracic echocardiography and computed tomography showed dissection of the ascending aorta, for which he underwent a redo Bentall procedure. The patient was weaned from cardiopulmonary bypass without any problem and discharged after 7 days.
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Affiliation(s)
- Safieh Boroumand
- Research Center for Advanced Technologies in Cardiovascular Medicine, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran.,Department of Tissue Engineering and Applied Cell Sciences, School of Advanced Technologies in Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Seyed Hossein Ahmadi-Tafti
- Research Center for Advanced Technologies in Cardiovascular Medicine, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Saeed Davoodi
- Research Center for Advanced Technologies in Cardiovascular Medicine, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyed Khalil Forouzannia
- Research Center for Advanced Technologies in Cardiovascular Medicine, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
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12
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Furukawa H. Current Clinical Implications of Frailty and Sarcopenia in Vascular Surgery: A Comprehensive Review of the Literature and Consideration of Perioperative Management. Ann Vasc Dis 2022; 15:165-174. [PMID: 36310738 PMCID: PMC9558142 DOI: 10.3400/avd.ra.22-00035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 06/15/2022] [Indexed: 11/27/2022] Open
Abstract
Frailty is a well-known geriatric syndrome of impaired physiological reserve and increased vulnerability to stressors. Sarcopenia is also used as a parameter of physical impairment characterized by muscle weakness. As population aging has become more prominent in recent years, both modalities are now regarded as clinically important prognostic tools defined by multidimensional factors that may affect clinical outcomes in various clinical settings. A preoperative surgical risk analysis is mandatory to predict clinical and surgical outcomes in all surgical practices, particularly in high-risk surgical patients. In vascular surgical settings, frailty and sarcopenia have been accepted as useful prognostic tools to evaluate patient characteristics before surgery, as these may predict perioperative clinical and surgical outcomes. Although minimally invasive surgical approaches, such as endovascular therapy, and hybrid approaches have been universally developed, achieving good vascular surgical outcomes for high-risk cohorts remains to be challenge due to the increasing prevalence of elderly patients and multiple preoperative co-morbidities in addition to frailty and sarcopenia. Therefore, to further improve clinical and surgical outcomes, these preoperative geriatric prognostic factors will be of great importance and interest in vascular surgical settings for both physicians and surgeons.
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Affiliation(s)
- Hiroshi Furukawa
- Department of Cardiovascular Surgery, Tokyo Women’s Medical University Adachi Medical Center
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13
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Hybrid Approach in Acute and Chronic Aortic Disease. Medicina (B Aires) 2021; 58:medicina58010049. [PMID: 35056357 PMCID: PMC8777634 DOI: 10.3390/medicina58010049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 12/20/2021] [Accepted: 12/23/2021] [Indexed: 11/26/2022] Open
Abstract
The management of patients with aortic disease that involves the ascending aorta, the aortic arch, and the descending aorta represent a surgical challenge. Open surgical repair remains the gold standard for aortic arch pathologies. However, this operation requires a cardiopulmonary bypass and a period of profound hypothermia and circulatory arrest, which carries a substantial rate of mortality and morbidity. For these reasons, hybrid arch repair that involves a combination of open surgery with endovascular aortic stent graft placement has been introduced as a therapeutic alternative for those patients deemed unfit for open surgical procedures. Hybrid repair requires varying degrees of invasiveness and can be performed as a single-stage procedure or as a two-stage procedure. The choice of the technique is multifactorial, depending on the characteristics of the diseased arch with regard to position of the stent graft proximal landing zone, patient fitness and comorbid status, as well as surgical expertise and hospital facilities. Among the evolving hybrid procedures is the so-called “frozen” or stented elephant trunk technique. Adapted from the classical elephant trunk technique, this approach facilitates the repair of a concomitant aortic arch and proximal descending aortic aneurysms in a single stage under circulatory arrest. This technique is increasingly being used to treat extensive thoracic aortic disease and has shown promising results.
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Juan S, Liangtao X, Ligang L, Xiang W, Mingjia M. Application of different types of hybrid aortic arch repair:Toward to solve dissection involving the aortic arch. Ann Vasc Surg 2021; 83:222-230. [PMID: 34954031 DOI: 10.1016/j.avsg.2021.11.023] [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: 05/10/2021] [Revised: 11/14/2021] [Accepted: 11/28/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To investigate the outcomes and effectiveness of different types of hybrid aortic arch repair for aortic dissection involving the aortic arch. METHODS From 2013 to 2020, 168 patients underwent hybrid aortic arch repair for dissection involving the aortic arch. We collected data from our electronic medical records, including the presenting pathology, perioperative details, and postoperative outcomes. We included the following types of hybrid aortic arch repair: classic type I, type II, and type III hybrid aortic arch repair, as well as the new type IV hybrid aortic repair. We defined type IV hybrid aortic arch repair as revascularization of supra-aortic branches through extra-anatomy bypass without sternotomy, followed by stent-graft placement. RESULTS There were 23, 82, and 63 patients who underwent type I, type II, and type IV hybrid aortic arch repair, respectively. There were no type III hybrid aortic repairs performed. Forty-nine cases were performed urgently. The technical success rate was 99.4%. The early mortality rates of the total group, type I group, type II group, and type IV group were 6.5%, 4.3%, 8.5%, and 4.8%, respectively. Postoperative complications mainly included tracheotomy (8.9%), stroke (6%), wound infection (4.2%), renal insufficiency (8.9%), and endoleak (7.7%). With a mean follow-up of 45.1±28.5 months, the total 1-year and 5-year actual survival rates were 93.5% and 89.0%, respectively. At 6 months, the aortic diameter at the level of the diaphragm decreased significantly (30.8±4.9 mm vs 28.5±6.3 mm, p=0.012), and the rate of thrombosis of the false lumen at the level of pulmonary bifurcation and diaphragm were 95.7% and 83.1%. Ten patients underwent reintervention of the aorta, including 7 endovascular reinterventions, 2 total thoracoabdominal aortic aneurysm repairs, and 1 open total arch replacement. For the total group, the free from aorta reintervention rate at 5 years was 91.4%. CONCLUSION Our results with hybrid aortic arch repair for aortic dissection involving the aortic arch are acceptable. The hybrid aortic arch repair could promote thrombosis of the distal false lumen while excluding intimal tears in the aortic arch.
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Affiliation(s)
- Shi Juan
- Division of Cardiothoracic and Vascular Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology
| | - Xia Liangtao
- Division of Cardiothoracic and Vascular Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology
| | - Liu Ligang
- Division of Cardiothoracic and Vascular Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology
| | - Wei Xiang
- Division of Cardiothoracic and Vascular Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology.
| | - Ma Mingjia
- Division of Cardiothoracic and Vascular Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology.
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Effectiveness of Proximal Landing Zones 0, 1, and 2 Hybrid Thoracic Endovascular Aortic Repair: A Single Centre 12 Year Experience. Eur J Vasc Endovasc Surg 2021; 63:410-420. [PMID: 34916108 DOI: 10.1016/j.ejvs.2021.10.043] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 10/13/2021] [Accepted: 10/17/2021] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Hybrid thoracic endovascular aortic repair (TEVAR) is being accepted increasingly as a first line treatment for arch repair at the present authors' institution. This study aimed to clarify the effectiveness of zones 0, 1, and 2 landing hybrid TEVAR. METHODS This was a retrospective single centre case series. From April 2008 to March 2020, 348 patients (median age 72 years; interquartile range [IQR] 65, 77 years) were enrolled, with a median follow up period of 5.6 years (IQR 2.6, 8.7 years). The procedures included zone 0 in 135 patients (38.8%), zone 1 in 82 patients (23.6%), and zone 2 proximal landing zone (LZ) hybrid TEVAR in 131 patients (37.6%). The pathologies consisted of dissecting aortic aneurysms in 123 (35.3%) patients. Emergency procedures were performed in 39 (11.2%) patients. RESULTS The 30 day mortality (n = 2, 0.6%) and hospital deaths (n = 6, 1.7%) were registered. The stroke rate was 1.1% (n = 4), while early and late endoleak rates were 4.8% (n = 17) and 1.7% (n = 6), respectively. Type 1a endoleak and retrograde type A dissection occurred in seven (2.0%) and three (0.9%) patients, respectively. The cumulative survival, freedom from aorta related deaths, and freedom from aortic events in 10 years were 75.0%, 97.2%, and 84.1%, respectively. The freedom from aortic events in each landing zone in 10 years was 82.3%, 81.4%, and 87.9% for zones 0, 1, and 2, respectively. The 10 year survival rates were 82.5% and 73.6%; the 10 year aorta related death free rates were 94.9% and 98.6%, and the 10 year aortic event free rates were 82.3% and 85.5% in the zone 0 and zone 1 and 2 TEVAR, respectively. CONCLUSION Satisfactory early and long term results of hybrid arch repair at zones 0, 1, and 2 were achieved. To avoid complications and aortic events, the treatment strategy of hybrid arch repair for aortic arch pathologies should be tailored using accurate pre-operative assessment of the ascending aorta and the aortic arch.
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Kudo T, Kuratani T, Shirakawa Y, Shimamura K, Kin K, Sakamoto T, Shijo T, Watanabe Y, Masada K, Sakaniwa R, Sawa Y. Comparison of the Outcomes of Total Endovascular Aortic Arch Repair Between Branched Endograft and Chimney Endograft Technique in Zone 0 Landing. J Endovasc Ther 2021; 29:427-437. [PMID: 34802327 DOI: 10.1177/15266028211059912] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE Zone 0 landing in thoracic endovascular aortic repair (TEVAR) has recently gained increasing attention for the treatment of high-risk patients. The aim of this study was to compare the outcomes of total endovascular aortic arch repair between branched TEVAR (bTEVAR) and chimney TEVAR (cTEVAR) in the landing zone (LZ) 0. MATERIALS AND METHODS This was a single-center, retrospective, and observational cohort study. From January 2010 to March 2020, 40 patients (bTEVAR, n=25; cTEVAR, n=15; median age: 79 years) were enrolled in this study, with a median follow-up period of 4.1 years. These patients were considered unsuitable for open surgical treatment. RESULTS All procedures were successful and no cases of conversion to open repair were noted during the 30-day postoperative period. The 30-day mortality was 2.5% (n=1; bTEVAR [0 of 25, 0%] vs cTEVAR [1 of 15, 6.7%]; p=0.375), the perioperative stroke rate was 10.0% (n=4; bTEVAR [4 of 25, 16.0%] vs cTEVAR [0 of 15, 0%], p=0.278), and type 1a endoleak rate was 15.0% (n=6; bTEVAR [0 of 25, 0%] vs cTEVAR [6 of 15, 40.0%], p=0.001). The risk factor for stroke was atheroma grade of ≥2 in the brachiocephalic artery (p<0.001). The risk factor for type 1a endoleak was cTEVAR (p=0.001). The 8-year survival rate was 49.9%. The aorta-related death-free rate and aortic event-free rate at 8 years were 94.4% (bTEVAR: 95.5% vs cTEVAR: 93.3%, p=0.504) and 60.7% (bTEVAR: 70.7% vs cTEVAR: 40.0%, p=0.048), respectively. CONCLUSIONS Total endovascular aortic arch repair using bTEVAR and cTEVAR is feasible for the treatment of aortic arch diseases in high-risk patients who are unsuitable for open surgery. However, as the rate of stroke is high, strict preoperative evaluation to prevent stroke is needed. No rupture of the aneurysm was observed in cTEVAR, but patients should be selected carefully because of the high incidence of type 1a endoleak.
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Affiliation(s)
- Tomoaki Kudo
- Department of Cardiovascular Surgery, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Toru Kuratani
- Department of Minimally Invasive Cardiovascular Medicine, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Yukitoshi Shirakawa
- Department of Cardiovascular Surgery, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Kazuo Shimamura
- Department of Minimally Invasive Cardiovascular Medicine, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Keiwa Kin
- Department of Cardiovascular Surgery, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Tomohiko Sakamoto
- Department of Cardiovascular Surgery, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Takayuki Shijo
- Department of Cardiovascular Surgery, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Yoshiki Watanabe
- Department of Cardiovascular Surgery, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Kenta Masada
- Department of Cardiovascular Surgery, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Ryoto Sakaniwa
- Department of Social Medicine, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Yoshiki Sawa
- Department of Cardiovascular Surgery, Graduate School of Medicine, Osaka University, Suita, Japan
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17
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Wallen T, Carter T, Habertheuer A, Badhwar V, Jacobs JP, Yerokun B, Wallace A, Milewski K, Szeto WY, Bavaria JE, Vallabhajosyula P. National Outcomes of Elective Hybrid Arch Debranching with Endograft Exclusion versus Total Arch Replacement Procedures: Analysis of the Society of Thoracic Surgeons Adult Cardiac Surgery Database. AORTA : OFFICIAL JOURNAL OF THE AORTIC INSTITUTE AT YALE-NEW HAVEN HOSPITAL 2021; 9:21-29. [PMID: 34607380 PMCID: PMC8489998 DOI: 10.1055/s-0041-1724003] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Hybrid arch procedures (arch vessel debranching with thoracic endovascular aneurysm repair [TEVAR] coverage of arch pathology) have been presented as an alternative to total arch replacement (TAR). But multicenter-based analyses of these two procedures are needed to benchmark the field and establish areas of improvement. METHODS The Society of Thoracic Surgeons (STS) Adult Cardiac Surgery Database from July 2014 to December 2015 was queried for elective TAR and hybrid arch procedures. Demographics and operative characteristics were compared and stepwise variable selection was used to create a risk-set used for adjustment of all multivariable models. RESULTS A total of 1,011 patients met inclusion criteria, 884 underwent TAR, and 127 had hybrid arch procedures. TAR patients were younger (mean age: 62.7 ± 13.3 vs. 66.7 ± 11.9 years; p = 0.001) and had less peripheral vascular disease (34.0 vs. 49.6%; p < 0.001) and preoperative dialysis (1.7 vs. 4.7%; p = 0.026), but similar history of stroke (p = 0.91)/cerebrovascular disease (p = 0.52). TAR patients had more concomitant procedures (60 vs. 34.6%; p < 0.0001). TAR patients had lower mortality (6.7 vs. 12.6%; p = 0.02), stroke (6.9 vs. 15%; p = 0.002), paralysis (1.8 vs. 7.1%; p = 0.002), renal failure (4.6 vs. 8.7%; p = 0.045), and STS morbidity (34.2 vs. 42.5%; p = 0.067). Composite mortality, stroke, and paralysis were significantly lower with TAR (11.5 vs. 25.2%; p = 0.0001). After risk adjustment, analysis showed hybrid arch procedures imparted an increased odds of mortality (odds ratio [OR] = 1.91, p = 0.046), stroke (OR = 2.3, p = 0.005), and composite endpoint of stroke or mortality (OR = 2.31, p = 0.0002). CONCLUSION TAR remains the gold standard for elective aortic arch pathologies. Despite risk adjustment, hybrid arch procedures were associated with increased risk of mortality and stroke, advocating for careful adoption of these strategies.
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Affiliation(s)
- Tyler Wallen
- Division of Cardiovascular Surgery, The University of Florida, Gainesville, Florida
| | - Timothy Carter
- Division of Cardiovascular Surgery, The University of Pennsylvania Health System, Philadelphia, Pennsylvania
| | - Andreas Habertheuer
- Division of Cardiovascular Surgery, The University of Florida, Gainesville, Florida
| | - Vinay Badhwar
- Division of Cardiac Surgery, West Virginia University Heart and Vascular Institute, Morgantown, West Virginia
| | - Jeffrey P Jacobs
- Division of Cardiovascular Surgery, The University of Florida, Gainesville, Florida
| | | | | | - Karianna Milewski
- Division of Cardiovascular Surgery, The University of Florida, Gainesville, Florida
| | - Wilson Y Szeto
- Division of Cardiovascular Surgery, The University of Florida, Gainesville, Florida
| | - Joseph E Bavaria
- Division of Cardiovascular Surgery, The University of Florida, Gainesville, Florida
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18
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Zhan Y, Kooperkamp H, Lofftus S, McGrath D, Kawabori M, Chen FY. Conventional open versus hybrid aortic arch repair: a meta-analysis of propensity-matched studies. J Thorac Dis 2021; 13:4714-4722. [PMID: 34527312 PMCID: PMC8411138 DOI: 10.21037/jtd-21-183] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 07/02/2021] [Indexed: 12/03/2022]
Abstract
Background Comparison of conventional (open) surgical versus hybrid aortic arch repair remains debatable. While the majority of previous comparative studies including meta-analyses contained primarily risk-unadjusted cohorts, those focusing on propensity-matched comparisons were limited by their small sample size. We aimed to compare outcomes of these two approaches through an up-to-date search and meta-analysis of the best evidence currently available in the literature. Methods The PubMed/MEDLINE, EMBASE, and Cochrane library from inception to September 2019 were searched to identify articles reporting propensity-score matching data on open versus hybrid aortic arch repair. Patients’ baseline characteristics and clinical outcomes were extracted from the articles and pooled for analysis. Heterogeneity and biases were assessed among the included studies. Results Five studies, including a total of 378 patients (189 pairs), were included in the study. The two groups were similar in patients’ baseline characteristics. Stroke rate favoured the open group [2.1% versus 14.3%, OR 0.18 (0.07, 0.46), P=0.0004, I2=0%]. There was no significant difference between the two groups with regard to paraplegia. The hybrid group had numerically higher short-term mortality, but lower rate of acute renal failure requiring dialysis. There was a statistically significant difference between the mid-term survivals of the open and hybrid groups, with lower pooled mortality seen for the open group at 1-year and 2-years (P=0.02). Conclusions Open and hybrid repairs do not offer equivalent outcomes. Compared with hybrid aortic arch repair, conventional surgical aortic repair could be associated with favourable outcomes including postoperative stroke. Hybrid repair does not appear to provide better survival. Operative approaches should be carefully selected in treating aortic arch pathology.
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Affiliation(s)
- Yong Zhan
- Division of Cardiac Surgery, Tufts Medical Center, Tufts University School of Medicine, Boston, MA, USA
| | - Hannah Kooperkamp
- Division of Cardiac Surgery, Tufts Medical Center, Tufts University School of Medicine, Boston, MA, USA
| | - Serena Lofftus
- Division of Cardiac Surgery, Tufts Medical Center, Tufts University School of Medicine, Boston, MA, USA
| | - Daniel McGrath
- Division of Cardiac Surgery, Tufts Medical Center, Tufts University School of Medicine, Boston, MA, USA
| | - Masashi Kawabori
- Division of Cardiac Surgery, Tufts Medical Center, Tufts University School of Medicine, Boston, MA, USA
| | - Frederick Y Chen
- Division of Cardiac Surgery, Tufts Medical Center, Tufts University School of Medicine, Boston, MA, USA
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Qiao Z, Chen S, Guo R, Zhong Y, Ge Y, Li C, Liu Y, Zhu J, Sun L. Comparison of Open Repair vs. the One-Stage Hybrid Extra-Anatomic Technique for Distal Aortic Arch Disease Treatment: Mid-term Outcomes With a Risk-Adjusted Analysis. Front Cardiovasc Med 2021; 8:725902. [PMID: 34504880 PMCID: PMC8421766 DOI: 10.3389/fcvm.2021.725902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 08/02/2021] [Indexed: 11/16/2022] Open
Abstract
Objective: This study aims to compare the short- and mid-term outcomes of the stented elephant trunk (SET) procedure combined with supra-arch branch reconstruction and one-stage hybrid arch repair combined thoracic endovascular aortic repair (TEVAR) with extra-anatomic bypass in the management of distal arch disease. Methods: From January 2009 to January 2019, 97 patients underwent one-stage hybrid arch repair combined with TEVAR with extra-anatomic bypass (HAR group), and 206 patients underwent the SET procedure with supra-arch branch reconstruction (SET group). We used inverse-probability-of treatment weighting (IPTW) to adjust baseline differences. Results: Before IPTW adjustment, there was no significant difference in operative mortality between the two groups (5.2 vs. 1.0%, P = 0.064). The incidences of stroke, spinal cord injury (SCI), acute kidney injury (AKI), and endoleak also showed no significant differences (4.1 vs. 0.5%, P = 0.066; 2.1 vs. 1.5%, P = 1.000; 0 vs. 1.0%, P = 0.831; 6.2 vs. 1.9%, P = 0.113, respectively). After IPTW adjustment, the incidences of stroke, SCI, and AKI showed no significant differences between the two groups (1.8 vs. 1.1%, P = 0.138; 0.8 vs. 1.6%, P = 0.448; and 0 vs. 0.7%, P = 0.148, respectively). However, the HAR group tended to have higher operative mortality and incidence of endoleak than the SET group (12.4 vs. 1.3%, P = 0.01; 9.9 vs. 1.8%, P = 0.031, respectively). In the multivariate analysis, open repair decreased the risks of endoleak (odds ratio [OR], 0.171, 95% CI, 0.060–0.401; P < 0.001) and operative mortality (OR, 0.093, 95% CI, 0.027–0.238; P < 0.001). The overall survival and event-free survival of the HAR group were significantly lower than those of the SET group (P < 0.001). Conclusion: One-stage hybrid arch repair combined TEVAR with extra-anatomic bypass and the SET procedure with supra-arch branch reconstruction both provided good postoperative treatment outcomes for distal arch disease. However, hybrid arch repair increased the risks of endoleak and operative mortality. The SET procedure provided better mid-term survival than hybrid arch repair without increasing operative mortality. Carefully selecting the indications for the procedure, while receiving close long-term follow-up, may improve the survival rate of patients undergoing hybrid arch repair.
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Affiliation(s)
- Zhiyu Qiao
- Department of Cardiovascular Surgery, Beijing Aortic Disease Center, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.,Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
| | - Suwei Chen
- Department of Cardiovascular Surgery, Beijing Aortic Disease Center, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.,Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
| | - Rutao Guo
- Department of Cardiovascular Surgery, Beijing Aortic Disease Center, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.,Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
| | - Yongliang Zhong
- Department of Cardiovascular Surgery, Beijing Aortic Disease Center, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.,Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
| | - Yipeng Ge
- Department of Cardiovascular Surgery, Beijing Aortic Disease Center, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.,Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
| | - Chengnan Li
- Department of Cardiovascular Surgery, Beijing Aortic Disease Center, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.,Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
| | - Yongmin Liu
- Department of Cardiovascular Surgery, Beijing Aortic Disease Center, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.,Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
| | - Junming Zhu
- Department of Cardiovascular Surgery, Beijing Aortic Disease Center, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.,Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
| | - Lizhong Sun
- Department of Cardiovascular Surgery, Beijing Aortic Disease Center, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.,Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
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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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Kudo T, Kuratani T, Shimamura K, Sakaniwa R, Sawa Y. Long-term results of hybrid aortic arch repair using landing zone 0: a single-centre study. Eur J Cardiothorac Surg 2021; 59:1227-1235. [PMID: 33580240 DOI: 10.1093/ejcts/ezab016] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 11/30/2020] [Accepted: 12/05/2020] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES Thoracic endovascular aortic repair (TEVAR) has been gradually extended to the aortic arch region, with improved results. However, the rates of strokes and endoleaks in a hybrid TEVAR remain high. The goal of this study was to clarify the effectiveness of a hybrid TEVAR with a zone 0 landing using our treatment strategy. METHODS From April 2008 to March 2020, a total of 102 patients were enrolled in this study, with a median follow-up period of 3.2 years. The procedures included total debranching TEVAR with graft replacement of the ascending aorta in 62 patients, total debranching TEVAR with ascending aorta banding in 19 patients and total debranching TEVAR without ascending aorta banding in 21 patients. RESULTS Thirty-day mortality and hospital deaths were 1.0% (n = 1) and 3.9% (n = 4), respectively. The rates of aortic complications and endoleaks during the first 30 days postoperatively were 8.8% (n = 9) and 4.9% (n = 5), respectively. There was no type 1a endoleak, whereas retrograde type A dissection occurred in 2 (2.0%) patients. The rate of late aortic events was 3.9% (n = 4); there were no late endoleaks or aneurysm ruptures. The 10-year survival rate was 73.7% [95% confidence interval (CI) 60.3-83.8%]. The 10-year rates of aorta-related deaths and aortic events when performing a competitive-risk analysis were 29.4% (95% CI 16.3-42.5%) and 7.2 (95% CI 23.0-51.4%), respectively. CONCLUSIONS Satisfactory early and long-term results of a hybrid TEVAR with a zone 0 landing were achieved using our treatment strategy. When performing hybrid TEVAR in zone 0, postoperative aortic events may be reduced by accurate preoperative assessment of the ascending aorta.
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Affiliation(s)
- Tomoaki Kudo
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Toru Kuratani
- Department of Minimally Invasive Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Kazuo Shimamura
- Department of Minimally Invasive Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Ryoto Sakaniwa
- Department of Social Medicine, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Yoshiki Sawa
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
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Liu Y, Liang S, Zhang B, Dun Y, Guo H, Qian X, Yu C, Sun X. Type II hybrid arch repair versus total arch replacement with frozen elephant trunk: a propensity score-matched analysis. Eur J Cardiothorac Surg 2021; 60:297-304. [PMID: 33939801 DOI: 10.1093/ejcts/ezab047] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 12/18/2020] [Accepted: 01/13/2021] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES The aim of this study was to evaluate the objective outcomes of type II hybrid arch repair (HAR) and total arch replacement with frozen elephant trunk (TAR with FET). METHODS Data from 528 patients who underwent aortic arch repair from January 2017 to June 2019 were collected, which consisted of 175 type II HAR and 353 TAR with FET. The propensity score-matched analysis identified a subgroup of 90 pairs. Perioperative data and mid-term follow-up results were assessed. RESULTS There was no significant difference in the composite adverse events (type II HAR, 20.6%, 36/175 vs TAR with FET, 17.8%, 63/353, P = 0.450). Multivariable logistic analysis of the 528 patients showed that the procedure type (type II HAR or TAR with FET) was not associated with composite adverse events, 30-day mortality or stroke. The 3-year survival rates were 84.8% in the type II HAR group and 90.1% in the TAR with FET group (P = 0.12). The 3-year reintervention-free rates in the type II HAR and TAR with FET groups were 98.7% and 96.5% (P = 0.22), respectively. After matching, no significant difference was found in the incidence of composite adverse events or the 3-year survival and reintervention-free rates. CONCLUSIONS No significant clinical differences were found in the early and mid-term outcomes of type II HAR and TAR with FET. The long-term outcomes remain to be investigated. Careful patient selection for individualized approaches is the key to taking full advantage of the 2 surgical procedures.
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Affiliation(s)
- Yanxiang Liu
- Department of Vascular Surgery, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shenghua Liang
- Department of Vascular Surgery, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Bowen Zhang
- Department of Vascular Surgery, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yaojun Dun
- Department of Vascular Surgery, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hongwei Guo
- Department of Vascular Surgery, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiangyang Qian
- Department of Vascular Surgery, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Cuntao Yu
- Department of Vascular Surgery, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiaogang Sun
- Department of Vascular Surgery, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Blanco Amil CL, Mestres Alomar G, Guarnaccia G, Luoni G, Yugueros Castellnou X, Vigliotti RC, Ramses R, Riambau V. The Initial Experience on Branched and Fenestrated Endografts in the Aortic Arch. A Systematic Review. Ann Vasc Surg 2021; 75:29-44. [PMID: 33831530 DOI: 10.1016/j.avsg.2021.03.024] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 03/01/2021] [Accepted: 03/11/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Branched and fenestrated endografts (fEVAR/bEVAR) are complex techniques used to treat thoracic aorta pathologies involving the aortic arch. This systematic review aims to determine all the reported results regarding these techniques in the aortic arch, in order to describe their clinical outcomes. METHODS A systematic review of the literature was performed, considering all articles published until October 2019. PubMed, Cochrane database resources were used. The protocol of the study was previously registered in the Prospero database (CRD42020147037). Primary exclusion criteria included opinion articles, merely technique descriptions, articles without the follow-up of at least 1 month, studies conducted on animals, mixed treatments, and ongoing trials without published data. Included variables were study design, aortic pathology, type of endovascular technique (fEVAR/bEVAR), endograft manufacturing, number of fenestrations/branches and type of bridge stents. Technical success, complications during surgery and follow-up were also described. RESULTS From a total of 164 articles, 29 (28 retrospective, 1 prospective) were analyzed with a total of 693 cases (341 fEVAR and 352 bEVAR). The most common indications for repair were aneurysm (54.8%) and dissection (40%). Only fEVAR and bEVAR were considered, but different endograft materials and techniques were used and, therefore, reported upon in the current review. Zenith Alpha Thoracic Endovascular Graft was the most representative (24% of cases). Custom made, off-the-shelf, physician modified and in situ fenestrated endografts were also used in 39%, 22.4%, 18.6% and 18.9% of cases, respectively. Bridge stents were implanted in the 50.5% of cases. Technical success rate was 96%. The main intraoperative complication was the endoleak (5.2%) followed by stroke (4.8%). The in-hospital mortality was 2.5%. The mean follow-up was 18.5 months. The mortality related to the main operation during follow-up was 3.2% and not directly related to the main operation was 11.3%. During the follow-up, 92 cases (13.3%) in total had to undergo through a reintervention, 46.7% with endovascular repair and 26.1% with open surgical repair (the rest were not specified). CONCLUSION published experience with bEVAR and fEVAR in the aortic arch showed acceptable short-term effectiveness and safety. More well-conducted prospective clinical studies with long term follow-up, combined with comparative meta-analysis, are needed to elucidate the real benefit of those endovascular techniques in the aortic arch pathology.
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Affiliation(s)
- Carla Lorena Blanco Amil
- Division of Vascular Surgery, Cardiovascular Institute, Hospital Clínic, University of Barcelona, Barcelona, Spain.
| | - Gaspar Mestres Alomar
- Division of Vascular Surgery, Cardiovascular Institute, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Giorgio Guarnaccia
- Division of Vascular Surgery, Cardiovascular Institute, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Giorgio Luoni
- Division of Vascular Surgery, Cardiovascular Institute, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Xavier Yugueros Castellnou
- Division of Vascular Surgery, Cardiovascular Institute, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Rossella Chiara Vigliotti
- Division of Vascular Surgery, Cardiovascular Institute, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Rafic Ramses
- Division of Vascular Surgery, Cardiovascular Institute, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Vincent Riambau
- Division of Vascular Surgery, Cardiovascular Institute, Hospital Clínic, University of Barcelona, Barcelona, Spain
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Ribeiro TS, Gadelha HDP, Santos MAD. Hybrid Repair versus Conventional Open Repair Approaches for Aortic Arch Disease: a Comprehensive Review. Braz J Cardiovasc Surg 2021; 36:244-252. [PMID: 33577263 PMCID: PMC8163269 DOI: 10.21470/1678-9741-2020-0382] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Objective To investigate whether hybrid repair has supremacy over conventional open repair in aortic arch diseases. Methods A comprehensive search was undertaken in two major databases (PubMed and MEDLINE) to identify all studies comparing the two surgical techniques in five years, up to December 2018, that met the established criteria in this study. The search returned 310 papers, and 305 were selected after removing duplicates. The abstracts of the remaining articles were assessed, resulting in 15 studies that went to full-text analysis. After application of the inclusion and exclusion criteria, 8 papers remained for the final revision. Results Eight studies met the criteria, with the inclusion of 1,837 patients. From a short-term perspective, hybrid repair and conventional open repair had similar outcomes in terms of postoperative mortality and acute neurological events. Hybrid repair was associated with less respiratory complications and risk of new intervention, as well as reduced hospital length of stay. Conventional open repair showed better mid- and long-term outcomes. Conclusion Hybrid repair should be used in selected patients, with a high risk or very high-risk profile for conventional surgery. Finally, since most of the current data were obtained from limited to large samples, with narrow follow-up and had great heterogeneity, the best approach to the aortic arch is still variable. Therefore, the decision of the approach should be individualized and evaluated by the whole Heart Team, considering the expertise of the surgical team.
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Affiliation(s)
- Tiago Santos Ribeiro
- Department of Integrated Medicine, Onofre Lopes University Hospital, Federal University of Rio Grande do Norte, Natal, Brazil
| | - Hernani de Paiva Gadelha
- Department of Integrated Medicine, Onofre Lopes University Hospital, Federal University of Rio Grande do Norte, Natal, Brazil
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Liang S, Liu Y, Zhang B, Li Y, Guo H, Shi Y, Sun X. A Comparison of Frozen Elephant Trunk, Aortic Balloon Occlusion, and Hybrid Repair for Total Arch Replacement. Semin Thorac Cardiovasc Surg 2021; 33:667-675. [DOI: 10.1053/j.semtcvs.2020.11.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 11/05/2020] [Indexed: 12/31/2022]
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26
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Elhelali A, Hynes N, Morris L, Delassus P, Kavanagh EP, Stefanov F, Fahy P, Sultan S. Open surgical repair vs. hybrid repair for treatment of aortic arch aneurysm: a systematic review and meta-analysis. ITALIAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY 2020. [DOI: 10.23736/s1824-4777.20.01443-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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27
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Liu Y, Liang S, Zhang B, Li Y, Wang L, Dun Y, Chen Z, Shi Y, Guo H, Sun X. Early outcomes of hybrid type II arch repair versus total arch replacement with frozen elephant trunk in acute DeBakey type I aortic dissection: a propensity score-matched analysis. Interact Cardiovasc Thorac Surg 2020; 31:565-572. [PMID: 32893301 DOI: 10.1093/icvts/ivaa121] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 04/06/2020] [Accepted: 06/07/2020] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES The aim was to evaluate the short-term outcomes of hybrid type II arch repair (HAR) and total arch replacement with frozen elephant trunk (TAR with FET) for acute DeBakey type I aortic dissection patients. METHODS From January 2017 to June 2019, the clinical data of acute DeBakey type I aortic dissection patients in a single centre were retrospectively reviewed; there were 92 cases of HAR and 268 cases of TAR with FET, with 56 pairs by propensity score matching. RESULTS After matching, the composite end points including 30-day mortality, stroke, paraplegia, renal failure, hepatic failure, reintubation or tracheotomy and low cardiac output syndrome were comparable (21.4%, 12/56 in the HAR group vs 21.4%, 12/56 in the TAR with FET group, P = 1.000). The rate of acute kidney injury (AKI) was significantly lower in the HAR group (58.9%, 33/56 vs 80.4%, 45/56, P = 0.031). The distribution of AKI stage according to the Kidney Disease Improving Global Outcomes criteria was different (P = 0.039), with more patients suffering from high-grade AKI in the TAR with FET group. Multivariable logistic analysis showed that the procedure type (HAR or TAR with FET) was not an independent predictor of composite adverse events or stroke. HAR was identified as a protective factor against AKI (odds ratio 0.485, 95% confidence interval 0.287-0.822; P = 0.007). CONCLUSIONS In the treatment of acute DeBakey type I aortic dissection, no significant differences were found in early outcomes between the 2 groups, but HAR was associated with a significantly lower incidence of AKI.
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Affiliation(s)
- Yanxiang Liu
- State Key Laboratory of Cardiovascular Disease, Vascular Surgery Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shenghua Liang
- State Key Laboratory of Cardiovascular Disease, Vascular Surgery Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Bowen Zhang
- State Key Laboratory of Cardiovascular Disease, Vascular Surgery Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yunfeng Li
- State Key Laboratory of Cardiovascular Disease, Vascular Surgery Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lucheng Wang
- State Key Laboratory of Cardiovascular Disease, Vascular Surgery Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yaojun Dun
- State Key Laboratory of Cardiovascular Disease, Vascular Surgery Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zujun Chen
- State Key Laboratory of Cardiovascular Disease, Vascular Surgery Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yi Shi
- State Key Laboratory of Cardiovascular Disease, Vascular Surgery Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hongwei Guo
- State Key Laboratory of Cardiovascular Disease, Vascular Surgery Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiaogang Sun
- State Key Laboratory of Cardiovascular Disease, Vascular Surgery Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Wang Z, Zhuang X, Chen B, Wen J, Wei M. Hybrid two-stage repair of Stanford A dissection with visceral or peripheral malperfusion. J Cardiothorac Surg 2020; 15:265. [PMID: 32972431 PMCID: PMC7517645 DOI: 10.1186/s13019-020-01307-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 09/17/2020] [Indexed: 11/10/2022] Open
Abstract
Background The present study aimed to evaluate the effect of two-stage hybrid aortic repair at the distal aorta of Stanford A dissection with malperfusion. Methods This retrospective case series included 20 patients with Stanford A dissection administered two-stage thoracic endovascular aortic repair (TEVAR) about 1 month after central repair because of visceral or limb malperfusion. The patients were examined by computed tomography (CT) angiography at 3, 6, 12 and 24 months after operation. Recovery of malperfusion and true lumen index were evaluated during follow-up. Results Twenty patients underwent two-stage hybrid aortic repair, including 11 males and 9 females. The follow-up time was 24 ± 7 months. No intervention-related complications were observed, including stent graft-induced new re-entry tears, death, stroke and spinal cord injury. Malperfusion in all cases was corrected. The true lumen was not enlarged enough 1 month after the first surgery. Thrombosis of the false lumen was observed around the elephant trunk at the carina level and the celiac artery. Three months after second stage TEVAR, the false lumen thrombosis was resorbed; in addition, the trunk was fully expanded at the carina level, and the true lumen was enlarged at the celiac artery. Conclusions Two-stage hybrid aortic repair for residual true lumen in the distal aorta 1 month after initial surgery is helpful for descending aorta remodeling and effective in treating malperfusion. This procedure may be a good option for patients suffering from Stanford A dissection with small true lumen in the distal aorta and malperfusion.
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Affiliation(s)
- Zanxin Wang
- Department of Cardiac Surgery, Fuwai Hospital Chinese Academy of Medical Sciences, Shenzhen, Guangdong, People's Republic of China.,Department of Cardiac Surgery, The University of Hong Kong - Shenzhen Hospital, Shenzhen, Guangdong, People's Republic of China
| | - Xianmian Zhuang
- Department of Cardiac Surgery, Fuwai Hospital Chinese Academy of Medical Sciences, Shenzhen, Guangdong, People's Republic of China
| | - Bailang Chen
- Department of Cardiac Surgery, Fuwai Hospital Chinese Academy of Medical Sciences, Shenzhen, Guangdong, People's Republic of China
| | - Junmin Wen
- Department of Intensive Care, Fuwai Hospital Chinese Academy of Medical Sciences, Shenzhen, Guangdong, People's Republic of China
| | - Minxin Wei
- Department of Cardiac Surgery, Fuwai Hospital Chinese Academy of Medical Sciences, Shenzhen, Guangdong, People's Republic of China. .,Department of Cardiac Surgery, The University of Hong Kong - Shenzhen Hospital, Shenzhen, Guangdong, People's Republic of China.
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Lei G, Wang G, Liu Q, Zhou H, Fang Z, Zhang C, Yang L, Shi S, Li J, Chen Y, Yang X. Single-Stage Hybrid Aortic Arch Repair is Associated With a Lower Incidence of Postoperative Acute Kidney Injury Than Conventional Aortic Surgery. J Cardiothorac Vasc Anesth 2019; 33:3294-3300. [DOI: 10.1053/j.jvca.2019.05.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Revised: 05/16/2019] [Accepted: 05/20/2019] [Indexed: 12/25/2022]
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Spinal cord injury following aortic arch replacement. Surg Today 2019; 50:106-113. [PMID: 31332530 DOI: 10.1007/s00595-019-01853-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Accepted: 07/07/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE Postoperative spinal cord injury is a devastating complication after aortic arch replacement. The purpose of this study was to determine the predictors of this complication. METHODS A group of 254 consecutive patients undergoing aortic arch replacement via median sternotomy, with (n = 78) or without (n = 176) extended replacement of the upper descending aorta, were included in a risk analysis. The frozen elephant trunk technique was used in 46 patients. The patients' atherothrombotic lesions (extensive intimal thickening of > 4 mm) were identified from computed tomography images. RESULTS Complete paraplegia (n = 7) and incomplete paraparesis (n = 4) occurred immediately after the operation (permanent spinal cord injury rate, 1.97%; transient spinal cord injury rate, 2.36%). A multivariable logistic regression analysis identified the use of the frozen elephant trunk technique (odds ratio 36.3), previous repair of thoracoabdominal aorta or descending aorta (odds ratio 29.4), proximal atherothrombotic aorta (odds ratio 9.6), chronic obstructive lung disease (odds ratio 7.1) and old age (odds ratio 1.1) as predictors of spinal cord injury (p < 0.0001, area under curve 0.93). CONCLUSIONS Spinal cord injury occurs with a non-negligible incidence following aortic arch replacement. The full objective assessment of the morphology of the whole aorta and the recognition of the risk factors are mandatory.
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Seike Y, Matsuda H, Fukuda T, Hori Y, Inoue Y, Omura A, Uehara K, Sasaki H, Kobayashi J. Is debranching thoracic endovascular aortic repair acceptable as the first choice for arch aneurysm in the elderly? Interact Cardiovasc Thorac Surg 2019; 29:101-108. [PMID: 30805619 DOI: 10.1093/icvts/ivz027] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 01/16/2019] [Accepted: 01/17/2019] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES This study aimed to assess differences in midterm outcomes between total arch replacement (TAR) and debranching thoracic endovascular aortic repair (d-TEVAR) and to evaluate the validity of d-TEVAR as the preferred treatment choice for aortic arch aneurysm in the elderly. METHODS We reviewed the case histories of 86 patients who had undergone TAR (64 men; mean age 78 ± 2.9 years) and 121 patients who had undergone d-TEVAR (90 men; mean age 82 ± 4.5 years) between 2007 and 2017; of these patients, 50 from each group were matched based on propensity scores to adjust for differences in patient characteristics. RESULTS Rates of freedom from all-cause mortality at 2 and 4 years were similar between the 2 groups (88% and 77% in the TAR group vs 82% and 64% in the d-TEVAR group, P = 0.11), but rates of freedom from reintervention at 2 and 4 years were significantly higher in the TAR group (100% and 96%) than in the d-TEVAR group (97% and 88%) (P = 0.004). Propensity score matching yielded similar survival rates of 88% and 85% for TAR vs 86% and 71% for d-TEVAR (P = 0.53) and comparable freedom from reintervention rates (100% and 97% in TAR, 98% and 90% in d-TEVAR, P = 0.16) at 2 and 4 years. Cox regression analysis identified previous cerebral infarction [hazard ratio (HR) 3.9; P = 0.005 in TAR/HR 3.1; P = 0.002 in d-TEVAR] as an independent positive predictor of overall mortality in both groups. CONCLUSIONS Midterm outcomes after TAR and d-TEVAR were satisfactory and propensity score matching-based evaluation revealed no significant differences in outcomes, implying that d-TEVAR is an acceptable first-choice procedure for aortic arch aneurysm in patients older than 75 years.
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Affiliation(s)
- Yoshimasa Seike
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Hitoshi Matsuda
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Tetsuya Fukuda
- Department of Radiology, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Yoshiro Hori
- Department of Radiology, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Yosuke Inoue
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Atsushi Omura
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Kyokun Uehara
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Hiroaki Sasaki
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Junjiro Kobayashi
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Osaka, Japan
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Srivastava S, Bhan A. Aortic arch aneurysms and dissection-open repair is the gold standard. Indian J Thorac Cardiovasc Surg 2019; 35:136-155. [PMID: 33061079 DOI: 10.1007/s12055-019-00819-w] [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: 12/09/2018] [Revised: 03/08/2019] [Accepted: 03/13/2019] [Indexed: 10/26/2022] Open
Abstract
The aortic arch repair is one of the most complex surgeries and carries a high risk of complications as well as mortality. Since 1975, when the arch repair was first done by Randall B. Griepp using hypothermic circulatory arrest, many new technologies were introduced. But even with the use of antegrade and retrograde perfusion techniques and improvement of surgical techniques and grafts, the rate of mortality, cerebral, spinal, and visceral damage was much higher as compared to any other cardiac surgeries. With further developments aimed at less invasive approaches, thoracic endovascular aortic repair (TEVAR) along with de-branching of supra-aortic vessels or the frozen elephant trunk was introduced. Here, in this article, we review the myriad of approaches to the aortic arch and have come to a conclusion that while traditional open surgery is considered as the gold standard for treatment of extensive aortic arch pathologies, one school of thought suggests hybrid techniques such as the frozen elephant trunk and aortic arch vessel de-branching as more appropriate procedures for high-risk patients, where co-morbidities may contraindicate cardiopulmonary bypass and longer operative times required for traditional repair. No randomized trials are present to compare between open and hybrid or endovascular procedure in normal or high-risk patients. The meta-analysis of most of the studies defines open surgery as the gold standard for arch pathology because the hybrid procedures did not provide any proven survival benefits or decrease in stroke rate and spinal ischemia when compared to open surgery in early, mid, or long-term results.
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Affiliation(s)
- Swarnika Srivastava
- Department of cardiothoracic surgery, Medanta The Medicity hospital, Gurugram, India.,Noida, India
| | - Anil Bhan
- Department of cardiothoracic surgery, Medanta The Medicity hospital, Gurugram, India
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Conventional Open Versus Hybrid Arch Repair of Aortic Arch Disease: Early and Long-Term Outcomes. Ann Thorac Surg 2019; 107:1380-1388. [DOI: 10.1016/j.athoracsur.2018.10.050] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 09/20/2018] [Accepted: 10/16/2018] [Indexed: 11/21/2022]
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Hsu HL, Huang CY, Chen PL, Chen YY, Hsu CP, Chen IM, Shih CC. Efficacy of ascending aortic banding technique concomitant with type I hybrid aortic arch repair in high-risk patients. Heart Vessels 2019; 34:1524-1532. [PMID: 30911784 DOI: 10.1007/s00380-019-01384-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Accepted: 03/15/2019] [Indexed: 11/26/2022]
Abstract
Banding of the ascending aorta has been introduced as a less complex procedure to optimize the proximal landing zone of the stent graft in hybrid aortic arch surgery. However, data about the long-term results and effects of this technique are still limited. We aimed to study the efficacy of banding of the ascending aorta in hybrid aortic arch repair. The study included 11 high-risk patients with dilated ascending aorta (wider than 38 mm in diameter) undergoing ascending aortic banding for hybrid arch repair. Clinical outcomes, including technical success, endoleaks, perioperative mortality and morbidity, and sequential remodeling of the ascending aorta were investigated. The average diameter of the ascending aorta had been reduced (p = 0.02) from 42.1 mm (range = 39.0-46.4) to 37.2 mm (range = 35.6-38.6) after banding procedure. The technical success rate was 100.0%. No type I endoleak occurred, but 2 cases of distal stent graft-induced new entry required re-interventions. The 5-year survival and freedom from aortic events rates both were 81.8%. The ascending aortic diameter remained stable and no proximal migration of the stent graft was observed during the study period. The 5-year results validated the durability of this therapeutic modality, especially in high-risk patients.
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Affiliation(s)
- Hung-Lung Hsu
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Department of Cardiovascular Surgery, Far Eastern Memorial Hospital, New Taipei City, Taiwan
- Department of Surgery, Taiwan Adventist Hospital, Taipei, Taiwan
| | - Chun-Yang Huang
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Division of Cardiovascular Surgery, Department of Surgery, Taipei Veterans General Hospital, #201, Section 2, Shipai Road, Taipei, Taiwan
| | - Po-Lin Chen
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Division of Cardiovascular Surgery, Department of Surgery, Taipei Veterans General Hospital, #201, Section 2, Shipai Road, Taipei, Taiwan
| | - Yin-Yin Chen
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Department of Surgery, Taiwan Adventist Hospital, Taipei, Taiwan
| | - Chiao-Po Hsu
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Division of Cardiovascular Surgery, Department of Surgery, Taipei Veterans General Hospital, #201, Section 2, Shipai Road, Taipei, Taiwan
| | - I-Ming Chen
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Division of Cardiovascular Surgery, Department of Surgery, Taipei Veterans General Hospital, #201, Section 2, Shipai Road, Taipei, Taiwan
| | - Chun-Che Shih
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan.
- School of Medicine, National Yang-Ming University, Taipei, Taiwan.
- Division of Cardiovascular Surgery, Department of Surgery, Taipei Veterans General Hospital, #201, Section 2, Shipai Road, Taipei, Taiwan.
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Joo HC, Youn YN, Kwon JH, Won JY, Lee DY, Ko YG, Choi D, Yoo KJ. Late complications after hybrid aortic arch repair. J Vasc Surg 2019; 70:1023-1030.e1. [PMID: 30922756 DOI: 10.1016/j.jvs.2019.01.058] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 01/08/2019] [Indexed: 10/27/2022]
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 supra-aortic 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 = 4) and early open conversion (n = 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 = 8), distal stent-induced new entry (n = 3), stent migration (n = 3), retrograde type A dissection (n = 2), aortopulmonary fistula (n = 2), aortoesophageal fistula (n = 1), stent fracture (n = 1), infection (n = 1), and sudden death (n = 4). Six of these patients (10%) underwent late open conversion. The overall survival rates at 3 years and 6 years were 71.1 ± 7.4% and 57.2 ± 11.3%, respectively. The aortic event-free rates at 3 years and 6 years were 52.1 ± 7.3% and 39.4 ± 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.
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Affiliation(s)
- Hyun-Chel Joo
- Division of Cardiovascular Surgery, Department of Thoracic and Cardiovascular Surgery, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
| | - Young-Nam Youn
- Division of Cardiovascular Surgery, Department of Thoracic and Cardiovascular Surgery, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Joon Ho Kwon
- Division of Radiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jong Yun Won
- Division of Radiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Do Yun Lee
- Division of Radiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Young-Guk Ko
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Donghoon Choi
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Kyung-Jong Yoo
- Division of Cardiovascular Surgery, Department of Thoracic and Cardiovascular Surgery, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
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Conservative treatment of type A aortic dissection following hybrid arch repair. Gen Thorac Cardiovasc Surg 2019; 67:602-607. [PMID: 30706293 DOI: 10.1007/s11748-019-01075-w] [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: 07/03/2018] [Accepted: 01/24/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVE Type A aortic dissection (TAAD) following hybrid arch repair (HAR) is a lethal complication. Open surgical repair is the ideal treatment, but this can be difficult, as most candidates have complications and are unsuitable for the conventional open aortic repair. We herein report three cases of TAAD after HAR and assess the treatment options. METHODS Of 261 aortic arch repair cases between April 2010 and March 2018, 38 underwent HAR using debranching of all the arch vessels followed by stent graft implantation landing proximally in zone 0 (type 1 HAR). Three cases suffered from TAAD, and their background characteristics and post-operative outcomes were studied retrospectively. RESULTS The three TAAD cases were elderly with a high risk of mortality due to comorbidities. TAAD for Cases 1, 2, and 3 was detected on post-operative day (POD) 11, POD11, and during the procedure, respectively. Case 1 was complicated with both respiratory and renal failures, and Case 3 suffered from severe neurological impairment when TAAD was detected. No additional open aortic repair was performed in any cases. Case 3 died on POD5 due to aortic rupture. Cases 1 and 2 have survived for more than 50 months since their initial surgeries. CONCLUSIONS TAAD following HAR can be detected with post-operative imaging despite a lack of signs noted during the intra- and post-operative periods. Conservative therapy might, therefore, be an acceptable option for subacute-onset TAAD following HAR with stable hemodynamics, even though such patients do required a very careful follow-up.
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Tokuda Y, Narita Y, Fujimoto K, Mutsuga M, Terazawa S, Ito H, Uchida W, Usui A. Neurologic Deficit After Aortic Arch Replacement: The Influence of the Aortic Atherosclerosis. Ann Thorac Surg 2019; 108:107-114. [PMID: 30710519 DOI: 10.1016/j.athoracsur.2019.01.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Revised: 12/06/2018] [Accepted: 01/02/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Postoperative neurologic deficits are associated with severe morbidity in aortic arch replacement. METHODS A group of 198 consecutive patients undergoing isolated total aortic arch replacement with the use of antegrade cerebral perfusion were analyzed for the risk factors for predicting neurologic deficit. With the use of computed tomography, atherothrombotic lesions (defined as extensive intimal thickening exceeding 4 mm) were identified in the proximal aorta (the ascending aorta or aortic arch) in 26.2% of cases and in the distal aorta in 34.9% of cases. RESULTS Permanent neurologic deficits occurred in 11.1% (including non-disabling stroke confirmed by imaging) and transient neurologic deficits in 8.1% of patients. A univariate analysis identified proximal atherothrombotic aorta (p = 0.0057), distal atherothrombotic aorta (p = 0.032), and retrograde systemic perfusion from the femoral artery in the presence of distal atherothrombotic aorta (p = 0.0022) as risk factors for neurologic deficits. A multivariate logistic regression analysis identified atherothrombotic proximal aorta (odds ratio 2.4, p = 0.033) as the independent risk factor. The presence of carotid stenosis did not affect the rate of neurologic deficit. Intracranial hemorrhagic lesions were found in 23% of permanent neurologic deficit cases. CONCLUSIONS Atherothrombotic lesions found by objectively graded computed tomography were predictors of neurologic deficit. Retrograde perfusion in the presence of a distal atherothrombotic lesion should be avoided whenever possible. Strategies based on the full assessment of the whole aortic morphologic characteristics appear to be mandatory. Anticoagulation therapy should be performed carefully to avoid intracranial hemorrhagic changes.
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Affiliation(s)
- Yoshiyuki Tokuda
- Department of Cardiac Surgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan.
| | - Yuji Narita
- Department of Cardiac Surgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Kazuro Fujimoto
- Department of Cardiac Surgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Masato Mutsuga
- Department of Cardiac Surgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Sachie Terazawa
- Department of Cardiac Surgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Hideki Ito
- Department of Cardiac Surgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Wataru Uchida
- Department of Cardiac Surgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Akihiko Usui
- Department of Cardiac Surgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
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Treatment of aortic arch aneurysms: Open surgery or hybrid procedure? TURK GOGUS KALP DAMAR CERRAHISI DERGISI-TURKISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2018; 26:351-358. [PMID: 32082763 DOI: 10.5606/tgkdc.dergisi.2018.15391] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Accepted: 03/27/2018] [Indexed: 11/21/2022]
Abstract
Background This study aims to compare the results of hybrid procedure and open surgery for the treatment of aortic arch aneurysms. Methods Twenty-six p atients (21 m ales, 5 females; m ean a ge 56.6±12.4 years; range, 20 to 83 years) who underwent total aortic arch replacement for aortic arch aneurysm between January 2004 and January 2010 were retrospectively analyzed. The patients were divided into two groups: open conventional surgery group (group 1, n=15) and hybrid procedure (total debranching of the aortic arch and simultaneous endovascular stent) group (group 2, n=11). Survival rates and need for reoperation were compared between the groups. Results The hybrid procedure was found to be more favorable in terms of postoperative revision, extubation period, and drainage amounts. However, there was no statistically significant difference in the survival rates, need for reoperation, and major adverse cardiovascular events between the groups. Conclusion Our study results suggest that conventional open surgery and hybrid procedure are similar in terms of survival and short-to-mid-term results in patients undergoing total aortic arch replacement for aortic arch aneurysm.
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Bashir M, Harky A, Bilal H. Is there a prospect for hybrid aortic arch surgery? Gen Thorac Cardiovasc Surg 2018; 67:132-136. [PMID: 29767819 DOI: 10.1007/s11748-018-0940-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Accepted: 05/08/2018] [Indexed: 10/16/2022]
Abstract
The surge of endovascular repair of aortic aneurysm in current modern aortic surgery practice has been the key for surgical management of elective cases of thoracic aortic aneurysms. This has paved way for the combined hybrid approach to be amongst the armamentarium for the management of aortic arch disease. The pivotal understanding of the aortic arch natural history coupled with device technology advancement allowed surgeons insight into delivery of hybrid surgery with acceptable morbidity and mortality results. This review article provides current insights into hybrid technique of aortic arch aneurysm repair and the evidences behind its applicability to arch surgery. It is aimed to highlight the challenges encountered for this innovative approach and correlate its challenges to those that are met by the conventional open aortic arch repair.
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Affiliation(s)
- Mohamad Bashir
- Department of Cardiac Surgery, Barts Heart Centre, St. Bartholomew's Hospital, West Smithfield, London, EC1A 7BE, UK.
| | - Amer Harky
- Department of Cardiac Surgery, Barts Heart Centre, St. Bartholomew's Hospital, West Smithfield, London, EC1A 7BE, UK.,Department of Cardiothoracic Surgery, Northwest Deanery, North West, Liverpool, UK
| | - Haris Bilal
- Manchester Royal Infirmary, Oxford Road, Manchester, M13 9WL, UK
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Chakos A, Jbara D, Yan TD, Tian DH. Long-term survival and related outcomes for hybrid versus traditional arch repair-a meta-analysis. Ann Cardiothorac Surg 2018; 7:319-327. [PMID: 30155410 DOI: 10.21037/acs.2018.05.07] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
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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Affiliation(s)
- Adam Chakos
- The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia
| | - Dean Jbara
- The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia
| | - Tristan D Yan
- The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia.,Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia.,Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, Sydney, Australia
| | - David H Tian
- The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia.,Royal North Shore Hospital, Sydney, Australia
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Preventza O, Tan CW, Orozco-Sevilla V, Euhus CJ, Coselli JS. Zone zero hybrid arch exclusion versus open total arch replacement. Ann Cardiothorac Surg 2018; 7:372-379. [PMID: 30155416 DOI: 10.21037/acs.2018.04.03] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Open total aortic arch replacement is one of the most technically demanding operations in cardiothoracic surgery, requiring operator expertise and intraoperative and postoperative teamwork. Despite current advancements in the field of open aortic surgery with regard to intraoperative brain protection and postoperative care, the morbidity and mortality associated with open total arch operations varies. Endovascular and hybrid procedures involving the use of zone 0 as a landing zone allow fair comparison between open total arch and hybrid operations. Hybrid procedures involving all of the other landing zones [1-4] should not be compared with open total arch replacement, as the extent of the pathology is different.
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Affiliation(s)
- Ourania Preventza
- Department of Cardiovascular Surgery, Texas Heart Institute, Houston, TX, USA.,Division of Cardiothoracic Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Corinne W Tan
- Division of Cardiothoracic Surgery, Baylor College of Medicine, Houston, TX, USA
| | | | - Caleb J Euhus
- Division of Cardiothoracic Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Joseph S Coselli
- Department of Cardiovascular Surgery, Texas Heart Institute, Houston, TX, USA.,Division of Cardiothoracic Surgery, Baylor College of Medicine, Houston, TX, USA
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Abstract
Conventional arch replacement can be carried out in a great majority of patients. Hybrid procedures are often as invasive and technically difficult as conventional ones. Moreover, their immediate results are, in many reported experiences, not better and their long-term results less favourable than the ones observed with conventional methods. So, yes, the open conventional arch replacement is still "the gold standard".
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Sometimes evolution requires a revolution. J Thorac Cardiovasc Surg 2017; 154:e99-e100. [PMID: 28947202 DOI: 10.1016/j.jtcvs.2017.08.087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Accepted: 08/26/2017] [Indexed: 11/24/2022]
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Mazzaccaro D, Sciarrini M, Nano G. Analysis of origin of the supra-aortic trunks from the aortic arch. J Vasc Surg 2017; 67:399-408. [PMID: 28830708 DOI: 10.1016/j.jvs.2017.04.076] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Accepted: 04/23/2017] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The objective of this study was to describe in the general population the anatomy of the supra-aortic trunks (SATs: brachiocephalic trunk [BCT], left common carotid artery [LCCA], and left subclavian artery [LSA]) arising from the aortic arch in terms of mutual distances from the valvular aortic plane (VAP), ostial diameters, and clock face orientation from the sagittal aortic axis, with an analysis of each distribution. METHODS Measurements of 252 computed tomography angiograms of the aortic arch and SATs in three groups of patients (84 without any disease of the aortic arch, group A; 84 with dilation of the aortic arch, group B; 84 with dilation of the descending thoracic aorta below the LSA, group C) were retrospectively collected and analyzed. The Shapiro-Wilk test was used to assess normality of each distribution. RESULTS The ostial diameters of the SATs followed a gaussian distribution in all groups. In group A, only VAP-BCT and LCCA-LSA distances were normal, being in 95% of cases between 46.6 and 88.2 mm and between 8 and 23.3 mm, respectively. In both groups B and C, the distance VAP-BCT and the takeoff angle of both LCCA and LSA were gaussian distributed (being in 95% of cases between 48.5 and 102.1 mm, -17.6° and 33°, and -17.7° and 23.4°, respectively, in group B; and between 51.3 and 101.1 mm, -28.2° and 33.7°, and -28.7° and 31.3°, respectively, in group C). VAP-BCT distance and BCT angle were lower in group A compared with group B (P < .001 and P = .008, respectively) and group C (P < .001 and P = .04, respectively). Irrespective of the group, all SAT mutual distances and ostial diameters were related to the aortic diameters, being greater for increasing aortic diameters. Neither BCT angle nor LSA angle was related to the aortic diameters, whereas LCCA angle was inversely correlated. CONCLUSIONS Most of the analyzed variables did not show a gaussian distribution, both in healthy and in diseased patients. Irrespective of the group, all SAT mutual distances and ostial diameters were related to the aortic diameters, being greater for increasing aortic diameters.
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Affiliation(s)
- Daniela Mazzaccaro
- First Unit of Vascular Surgery, IRCCS Policlinico San Donato, San Donato Milanese, Italy.
| | | | - Giovanni Nano
- First Unit of Vascular Surgery, IRCCS Policlinico San Donato, San Donato Milanese, Italy; Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
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Xydas S, Mihos CG, Williams RF, LaPietra A, Mawad M, Wittels SH, Santana O. Hybrid repair of aortic arch aneurysms: a comprehensive review. J Thorac Dis 2017; 9:S629-S634. [PMID: 28740717 PMCID: PMC5505941 DOI: 10.21037/jtd.2017.06.47] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Accepted: 05/24/2017] [Indexed: 11/06/2022]
Abstract
Open total arch replacement (TAR) has become safer with refinements in cerebral protection techniques. The frequent extension of aortic arch aneurysms into the descending thoracic aorta customarily requires a two-staged conventional elephant trunk procedure, carrying relatively high mortality and morbidity risks and high rates of rupture in the interval between the two open surgeries. The technical demands and invasive nature of TAR has therefore precluded many high-risk patients from being surgical candidates for aneurysm repair. As a result, hybrid techniques and approaches to the aortic arch have become common since the adoption of thoracic endovascular aortic repair (TEVAR) and advancement in the commercial grafts that are available. The results of hybrid aortic arch repairs have been encouraging, though with higher rates of re-interventions than TAR and variable reported rates of stroke and spinal cord ischemia. The aim of this publication is to review the current literature on hybrid repair of aortic arch aneurysms.
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Affiliation(s)
- Steve Xydas
- The Columbia University Division of Cardiac Surgery, Mount Sinai Medical Center, Miami Beach, FL, USA
| | - Christos G. Mihos
- Cardiac Ultrasound Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Roy F. Williams
- The Columbia University Division of Cardiac Surgery, Mount Sinai Medical Center, Miami Beach, FL, USA
| | - Angelo LaPietra
- The Columbia University Division of Cardiac Surgery, Mount Sinai Medical Center, Miami Beach, FL, USA
| | - Maurice Mawad
- The Columbia University Division of Cardiac Surgery, Mount Sinai Medical Center, Miami Beach, FL, USA
| | - S. Howard Wittels
- The Department of Anesthesia, Mount Sinai Medical Center, Miami Beach, FL, USA
| | - Orlando Santana
- The Columbia University Division of Cardiology, The Mount Sinai Heart Institute, Miami Beach, FL, USA
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Hiraoka A, Chikazawa G, Totsugawa T, Tamura K, Ishida A, Sakaguchi T, Yoshitaka H. Objective analysis of midterm outcomes of conventional and hybrid aortic arch repair by propensity-score matching. J Thorac Cardiovasc Surg 2017; 154:100-106.e1. [PMID: 28314530 DOI: 10.1016/j.jtcvs.2016.12.060] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Revised: 11/18/2016] [Accepted: 12/12/2016] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The aim of this study is to evaluate the objective outcomes of conventional total aortic arch repair (CTAR) and hybrid arch repair by using propensity-score matching to reduce selection bias. METHODS Between January 2006 and April 2016, 470 consecutive patients underwent isolated aortic arch repair (excluding hemiarch or partial arch reconstruction, and cases with concomitant cardiac surgeries) at a single cardiovascular institute. We categorized 337 total aortic arch repair with antegrade cerebral perfusion under circulatory arrest as the CTAR group and 58 hybrid aortic arch repair (HAR) with thoracic endovascular aortic repair as the HAR group. Seventy-five patients with scheduled and staged thoracic endovascular aortic repair after total aortic arch repair with elephant trunk were excluded. Then, we compared early and midterm outcomes between the propensity-matched group (43 CTAR vs HAR pairs). RESULTS There were no significant differences in 30-day and operative deaths between the CTAR and HAR groups (4.7% [2/43] vs 7.0% [3/43]; P = .4142 and 11.6% [5/43] vs 16.3% [7/43]; P = .5637). Although there were no significant differences in the incidences of other major complications, permanent stroke was observed more frequently in the HAR group (0% [0/43] vs 11.6% [5/43]; P = .0064) compared with the CTAR group. Matching analysis, however, revealed an equivalent 5-year survival rate between the CTAR and HAR groups (80.5% vs 59.9%; P = .1300). CONCLUSIONS Matching analysis revealed a significantly greater incidence of stroke in the HAR group but equivalent midterm outcomes in the hybrid group compared with the CTAR group.
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Affiliation(s)
- Arudo Hiraoka
- Department of Cardiovascular Surgery, The Sakakibara Heart Institute of Okayama, Japan.
| | - Genta Chikazawa
- Department of Cardiovascular Surgery, The Sakakibara Heart Institute of Okayama, Japan
| | - Toshinori Totsugawa
- Department of Cardiovascular Surgery, The Sakakibara Heart Institute of Okayama, Japan
| | - Kentaro Tamura
- Department of Cardiovascular Surgery, The Sakakibara Heart Institute of Okayama, Japan
| | - Atsuhisa Ishida
- Department of Cardiovascular Surgery, The Sakakibara Heart Institute of Okayama, Japan
| | - Taichi Sakaguchi
- Department of Cardiovascular Surgery, The Sakakibara Heart Institute of Okayama, Japan
| | - Hidenori Yoshitaka
- Department of Cardiovascular Surgery, The Sakakibara Heart Institute of Okayama, Japan
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Valentine RJ, Boll JM, Hocking KM, Curci JA, Garrard CL, Brophy CM, Naslund TC. Aortic arch involvement worsens the prognosis of type B aortic dissections. J Vasc Surg 2016; 64:1212-1218. [DOI: 10.1016/j.jvs.2016.04.054] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Accepted: 04/26/2016] [Indexed: 12/19/2022]
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Kotha VK, Herget EJ, Appoo JJ. Complications at the Proximal Landing Zone of Endovascular Stent Grafts Deployed in Surgically Replaced Ascending Aorta. Ann Thorac Surg 2016; 102:1490-1497. [DOI: 10.1016/j.athoracsur.2016.04.046] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2015] [Revised: 02/29/2016] [Accepted: 04/11/2016] [Indexed: 10/21/2022]
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Miao L, Song L, Sun SK, Wang ZG. Meta-analysis of open surgical repair versus hybrid arch repair for aortic arch aneurysm. Interact Cardiovasc Thorac Surg 2016; 24:34-40. [DOI: 10.1093/icvts/ivw305] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Revised: 08/03/2016] [Accepted: 08/08/2016] [Indexed: 11/14/2022] Open
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