TY - JOUR
T1 - A case series of a hybrid approach to aortic arch disease
AU - Michler, Robert E.
AU - Lipsitz, Evan
AU - Neragi-Miandoab, Siyamek
PY - 2013/8
Y1 - 2013/8
N2 - Objective: Debranching of the aortic arch and endovascular stent placement as a combination therapy for complex aortic arch pathology has emerged over the past few years as an alternative to traditional repair. This hybrid approach is a viable option for patients who would not tolerate conventional arch replacement, as well as for patients with a failed stent graft of the descending aorta and a subsequent type I endoleak. Methods: We retrospectively reviewed the preoperative characteristics and postoperative outcomes of 5 patients who underwent debranching of the aortic arch and implantation of an endovascular stent across the aortic arch between 2008 and 2011. Data were analyzed with the Student t test and the Kaplan-Meyer method. Results: The mean age was 70.6 ± 18 years; 4 men and 1 woman were evaluated. One patient had previous aortic surgery for dissection. The preoperative morbidities included arrhythmia (1 patient), chronic obstructive pulmonary disease (2 patients), cerebrovascular accident (1 patient), diabetes mellitus (2 patients), coronary artery disease (2 patients), and active angina (1 patient). One patient had a myocardial infarction 3 weeks before surgery. The primary technicalsuccess rate was 100%, and none of the patients died in the perioperative phase. The mean follow-up time was 22 ± 18.4 months, and the median follow-up time was 13.8 months (range, 7.13-50.7 months). Two patients died during followup. The pathology of the aorta in the patients who died was arch aneurysm; the 3 remaining patients are alive and regularly followed at our institution. Conclusion: The combination of surgery and simultaneous endovascular stenting in the operating room is an alternative approach for patients who are poor candidates for traditional arch repair under circulatory arrest.
AB - Objective: Debranching of the aortic arch and endovascular stent placement as a combination therapy for complex aortic arch pathology has emerged over the past few years as an alternative to traditional repair. This hybrid approach is a viable option for patients who would not tolerate conventional arch replacement, as well as for patients with a failed stent graft of the descending aorta and a subsequent type I endoleak. Methods: We retrospectively reviewed the preoperative characteristics and postoperative outcomes of 5 patients who underwent debranching of the aortic arch and implantation of an endovascular stent across the aortic arch between 2008 and 2011. Data were analyzed with the Student t test and the Kaplan-Meyer method. Results: The mean age was 70.6 ± 18 years; 4 men and 1 woman were evaluated. One patient had previous aortic surgery for dissection. The preoperative morbidities included arrhythmia (1 patient), chronic obstructive pulmonary disease (2 patients), cerebrovascular accident (1 patient), diabetes mellitus (2 patients), coronary artery disease (2 patients), and active angina (1 patient). One patient had a myocardial infarction 3 weeks before surgery. The primary technicalsuccess rate was 100%, and none of the patients died in the perioperative phase. The mean follow-up time was 22 ± 18.4 months, and the median follow-up time was 13.8 months (range, 7.13-50.7 months). Two patients died during followup. The pathology of the aorta in the patients who died was arch aneurysm; the 3 remaining patients are alive and regularly followed at our institution. Conclusion: The combination of surgery and simultaneous endovascular stenting in the operating room is an alternative approach for patients who are poor candidates for traditional arch repair under circulatory arrest.
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U2 - 10.1532/HSF98.20131022
DO - 10.1532/HSF98.20131022
M3 - Article
C2 - 23958537
AN - SCOPUS:84883376500
SN - 1098-3511
VL - 16
SP - E225-E231
JO - Heart Surgery Forum
JF - Heart Surgery Forum
IS - 4
ER -