Open AccessJournal Article
Hybrid aortic procedures for endoluminal arch replacement in thoracic aneurysms and type B dissections.
Hardy Schumacher,H. von Tengg-Kobligk,Marko Ostovic,V. Henninger,Stefan Ockert,D Böckler,Jens-Rainer Allenberg +6 more
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TLDR
Hybrid aortic arch repair is technically challenging but feasible and may be an alternative to standard open procedures in high-risk patients and emergency cases, however, the promising early results need to be confirmed by longer follow-up and larger series.Abstract:
The aim of this study was to report our clinical experience with and review current literature on endoluminal aortic hybrid techniques and to evaluate outcome in high-risk patients treated for complex aortic arch lesions combining conventional supra-aortic debranching bypasses with subsequent or staged thoracic endovascular grafting. Of 172 patients treated with thoracic endografts for different thoracic aortic pathologies within the last 8 years, the mid-aortic arch was involved in 25, i.e. at least the left common carotid artery had to be overstented and revascularized to provide a proper proximal landing zone. These debranching bypasses were performed as a simultaneous or a staged procedure. All patients were at high-risk and were excluded by cardiac surgeons as ineligible for conventional arch repair. After partial (n=16) or complete (n=9) supra-aortic transposition, 4 different commercially available endografts (80% TAG, WL Gore) were implanted transfemorally or via iliac conduit. Deployment success was 100% in 25 patients after simultaneous or staged supra-aortic transposition; in 32% an emergency procedure was performed due to contained rupture; in 36% more than 1 endograft system was implanted (2 in 20%, 3 in 8% und 4 in 8%). The overall perioperative thirty-day mortality was 5 of 25 (20%) due to interoperative proximal bare stent perforation (n=1), transfusion related acute lung injury (TRALI n=1), cardiac failure (n=1), embolic stroke (n=1) and pneumonia (n=1). The mean follow-up was 21 months. All endoleaks type I (n=3) were corrected with another endograft; the 2 endoleaks type II sealed spontaneously. The major adverse events were: prolonged ventilation in 5 (20%), temporary renal insufficiency with hemodialysis (n=2), bypass infection (n=1), without any complications (n=9). No cases of paraplegia were recorded. Hybrid aortic arch repair is technically challenging but feasible. This novel approach may be an alternative to standard open procedures in high-risk patients and emergency cases. However, the promising early results need to be confirmed by longer follow-up and larger series.read more
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Journal ArticleDOI
Systematic review of clinical outcomes in hybrid procedures for aortic arch dissections and other arch diseases
Piergiorgio Cao,Paola De Rango,Martin Czerny,Arturo Evangelista,Rossella Fattori,Christoph A. Nienaber,Hervé Rousseau,Marc A.A.M. Schepens +7 more
TL;DR: In this paper, the authors provide a pooled analysis of periprocedural mortality and neurologic outcomes in hybrid procedures involving the aortic arch for dissection and other aortal diseases.
Journal ArticleDOI
Hybrid treatment of complex aortic arch disease with supra-aortic debranching and endovascular stent graft repair
TL;DR: A systematic literature review and analysis of the reported outcomes was undertaken in this paper, where technical success, perioperative, 30-day and late morbidity and mortality were evaluated.
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Short and midterm results after left subclavian artery coverage during endovascular repair of the thoracic aorta
Drosos Kotelis,Philipp Geisbüsch,Ulf Hinz,Alexander Hyhlik-Dürr,Hendrik von Tengg-Kobligk,Jens R. Allenberg,Dittmar Böckler +6 more
TL;DR: By using a selective approach to the LSA revascularization, coverage of the L SA can be used to extend the proximal seal zone for TEVAR without increasing the risk of spinal cord ischemia or stroke.
Journal ArticleDOI
Hybrid procedures for thoracoabdominal aortic aneurysms and chronic aortic dissections – A single center experience in 28 patients
Dittmar Böckler,Drosos Kotelis,Philipp Geisbüsch,Alexander Hyhlik-Dürr,K. Klemm,Hendrik von Tengg-Kobligk,Hans-Ulrich Kauczor,Jens-Rainer Allenberg +7 more
TL;DR: Early results of visceral hybrid repair for high-risk patients with complex and extended TAAAs and CEADs are encouraging in a selected group of high risk patients in whom open repair is hazardous and branched endografts are not yet optional.
Journal ArticleDOI
Hybrid repair of thoracic aortic lesions for zone 0 and 1 in high-risk patients.
Nadia Vallejo,Julio A. Rodriguez‐Lopez,Paniz Heidari,Grayson H. Wheatley,David J. Caparrelli,Venkatesh G. Ramaiah,Edward B. Diethrich +6 more
TL;DR: The hybrid approach for repair of the aortic arch pathologies is feasible in patients unfit for open repair with antegrade or retrograde inflow, stenting of the branches or a combination of both.