Early and mid-term results of type II hybrid arch repair with zone 0 stent graft deployment for type A aortic dissection

Abstract

Objective By analyzing the early- and mid-term clinical results of type Ⅱ hybrid arch repair for the treatment of aortic A aortic dissection, the efficacy of hybridization technique in the application of type A aortic dissection was evaluated systematically. Methods We retrospectively studied the records of patients with DeBakey type I dissection who were admitted to the Beijing Fuwai hospital between January 2010 and December 2016. 122 continuous patients underwent hybrid aortic arch repair without deep hypothermic circulatory arrest, the landing zone of stent was located in ascending aorta (Zone 0) . All patients were followed up by clinic or telephone review, aortic computed tomography (CT) were checked before surgery and discharge time. All patients were reviewed by CT during 3-6 month after first discharge and once per year during follow up thereafter. Results The average age of all patients was (61±7) years, male patients accounted for 66.4%, patients with acute dissection accounted for 85.2%, there were 39 patients (32%) with different degree of preoperative poor organ perfusion. A total of 154 stents were implanted in 122 patients, sinus plasty was performed in 26 patients (21.3%) , valvuloplasty was performed in 39 patients (32%) , coronary bypass surgery was performed in 9 patients (7.4%) . The average time of cardiopulmonary bypass (CPB) time was (135.3±38.9) minutes, cross clamp time was (58.3±27.8) minutes, 117 patients (95.9%) were completed under non-stop circulation. There were 11 cases of early death (9%) , 19 cases of complex complication (15.6%) , and 28 cases of postoperative renal insufficiency (23%) . No cerebral infarction or paraplegia occurred after operation, 3 patients (2.5%) developed temporary spine cord paralysis. Multiple regression analysis showed that postoperative renal insufficiency (OR: 12.75, 95%CI: 1.77-38.30, P=0.034) and postoperative gastrointestinal insufficiency (OR: 24.03, 95%CI: 2.26-55.61, P=0.008) were the independent risk factors of death for all patients. Operative duration (OR: 2.36, 95%CI: 0.58-2.33, P=0.030) , postoperative renal insufficiency (OR: 20.18, 95%CI: 4.93-82.67, P<0.001) and postoperative gastrointestinal insufficiency (OR: 11.54, 95%CI: 2.29-58.08, P=0.003) were the independent risk factors of composited complication. Average follow-up time was 32.9±25.2 months. There were 92 cases of complete thrombus formation of false lumen in stent (86.8%) , 14 cases of partial thrombus formation (13.2%) , there were 9 cases of thoracic segment tumor like dilation (8.5%) , 9 cases of abdominal segment tumor like dilation (8.5%) . During follow up period, 7 cases died (6.6%) . The survival rates of 3, 5 and 7 years after operation were 94.7%, 91% and 91%, respectively, reintervention rate was 2.8% (3 cases) , the free from reoperation rates of 3, 5 and 7 years after operation were 98%, 92.4% and 92.4%, respectively. Conclusions This single-stage hybrid arch procedure offers an alternative approach to type A dissection and associated with acceptable early and midterm major morbidity and mortality. However, given the high rate of renal dysfunction, more attention is required for further application. Key words: Hybrid aortic repair; Aortic dissection; Deep hypothermic circulatory arrest