Complex aortic arch aneurysm and dissections: hybrid techniques for surgical and endovascular therapy

Abstract

Open aortic arch surgery is highly invasive and may result in significant morbidity. Recent innovations in thoracic stent-graft technology have facilitated methods of replacing the aortic arch without deep hypothermic circulatory arrest or even cardiopulmonary bypass. We present a review of the current techniques and results of hybrid aortic arch surgery centered around a new classification scheme for these procedures. Hybrid arch techniques have been developed to address various arch disorders, including aneurysmal disease and aortic dissections. In some cases, new proximal or distal landing zones need to be created for adequate seal. Preliminary results show that hybrid arch procedures are potentially beneficial versus open surgery in elderly, very high-risk patients but that this advantage may not be as pronounced in younger lower risk patients. Although still highly experimental, totally endoscopic approaches to aortic arch surgery have been performed successfully. Hybrid approaches to aortic arch disorder continue to evolve as techniques and technology are further refined. Further long-term outcome data on these procedures will delineate their role in the future.