Is Hybrid Surgery for Aortic Diseases Involving Ascending Aorta and Proximal Aortic Arch Superior to Conventional Open Total Arch Replacement?

Jia Hu, ZHENG-HUA XIAO, HONG-WEI ZHANG, PENG YANG, YAO HUANG, ER-YONG ZHANG

West China Hospital, Si Chuan University, China, ChengDu, China

Date, time and location: 2018.05.26 13:30, Congress Hall, 2F–A

Abstract

Objective: We sought to describe and compare the short-midterm results of hybrid surgery and open total arch replacement for aortic diseases involving ascending aorta and proximal aortic arch.

Methods: From January 2013 to June 2017, 474 patients with aortic diseases involving ascending aorta (Zone 0) and proximal aortic arch (Zone 1) were retrospectively studied from a prospective database. Patients underwent hybrid aortic arch repair with at least one carotid artery revascularization and subsequent stent graft deployment were matched (case: control=1:2) for the age (± 5), gender, aortic pathology and emergency with open repair patients. Perioperative and 30-day and late postoperative results were recorded and compared.

Results: Sixty-six patients with hybrid arch repair were matched with 132 open repair patients. Both groups were comparable for patient’s demographics and intraoperative findings. Of the 66 patients, 32 (48.5%) were type A aortic dissection, 26 (39.4%) were aneurysm, and 8 patients (12.1%) were retrograde type B aortic dissection. Superior outcomes in terms of less ICU (2.3±1.8 vs. 7.8±2.1 days, p<0.01) and hospital stay (7.5±2.1 vs. 14.9±4.4 days, p<0.001), lower major adverse events (6/66, 9.1% vs. 33/132, 25%, p=0.026) and mortality (2/66, 3% vs. 18/132, 13.6%; p=0.032) were observed in patients with hybrid repair during perioperative period. The mean follow-up period was 21 months (range 6-54 months). Aortic-related postoperative morbidity (3/66, 4.5% vs. 11/132, 8.3%; p=0.358) and mortality (1/66, 1.5% vs. 7/132, 5.3%; p=0.218) were not significantly different between groups.

Conclusions: Less traumatic repair of proximal aortic diseases using hybrid techniques, where applicable, could achieve superior perioperative and not inferior short-midterm outcomes comparing conventional open total arch replacement. Long-term surveillance and follow-up is mandatory.