Hybrid Aortic Arch Debranching and TEVAR Is Safe in a Private, Community Hospital

Abstract

Hybrid open cervical vessel debranching and thoracic endovascular aortic repair (TEVAR) is a treatment option in the management of aortic arch or proximal descending thoracic aortic aneurysms. However, these patients are often referred to tertiary care academic centers for aneurysm repair. Our study looks to assess the safety and outcomes of open cervical debranching and TEVAR within a private, community hospital setting. A total of 12 patients underwent hybrid open cervical vessel debranch with staged TEVAR from 2015 to 2018 at Riverside Community Hospital (Riverside, California). Three patients underwent open sternotomy with innominate artery bypass; four patients underwent combined carotid-carotid bypass with left carotid-axillary bypass or left subclavian transposition; three patients solely underwent left carotid-axillary bypass or left subclavian transposition. In cases involving multiple cervical bypasses, two surgeons were present. TEVAR was performed in a staged fashion during the same hospitalization. There were no patient deaths, MI, or stroke within the 30-day postoperative period and at 1-year follow-up. One patient suffered a small subdural bleed after ascending aorta to innominate bypass involving redo sternotomy and hypothermic circulatory arrest. The mean aortic zone stented was zone 1. On follow-up imaging, all bypass grafts were patent, all aneurysms demonstrated thrombosis without endoleak. Average follow-up was 20months. Hybrid cervical debranching with staged TEVAR can be safely performed by experienced vascular surgeons in the community setting. Staged repair appears to confer better operative and patient outcomes.