Hemi–aortic arch debranching for hybrid aortic arch repair by sequential transposition of the left common carotid and subclavian arteries

Abstract

The aim of this study was to assess the short-term and midterm results after hemi-aortic arch debranching for hybrid aortic arch repair by sequential transposition of the left common carotid artery and of the left subclavian artery. From November 1998 to August 2011, 11 patients underwent a hybrid technique with supra-aortic debranching (by sequential transposition of the left common carotid artery and of the left subclavian) and simultaneous endovascular stent grafting for zone 1 lesions. There were 8 men and 3 women (mean age, 62.9 ± 20.9 years; range, 15-89 years). Aortic arch lesions treated included 4 complicated aortic dissections, 3 degenerative aneurysms, 2 postcoarctectomy aortic pseudoaneurysms, 1 mycotic aneurysm, and 1 traumatic transection of the arch. Four (36%) operations were performed in an emergency setting. Endovascular exclusion success was achieved in 90.9% of the patients (type I endoleak: 1/11). One iliac artery rupture occurred intraoperatively. The 30-day mortality rate was 0%. Overall actuarial survival was 82% and 71.8% at 1 and 2 years. Mean follow-up is 31 ± 25 months (range, 3-72 months). No instance of permanent cerebral or spinal cord ischemia was observed. Two type II endoleaks are currently observed. There was no device migration. Hybrid aortic arch repair by sequential transposition of the left common carotid artery and of the left subclavian artery for zone 1 lesions provides an attractive alternative for treating hemi-aortic arch lesions in high-risk patients with minimal atherosclerotic disease in the aorta and great vessels with acceptable primary results and encouraging midterm efficacy to prevent rupture. This hybrid strategy avoiding prosthetic bypass offers several advantages over conventional repair, including the potential to treat patients who are not candidates for open repair and single-stage treatment of some pathologic conditions previously requiring 2-stage repair.