Hybrid Aortic Arch Repair Procedure: Reinforcement of the Aorta for a Safe and Durable Landing Zone

Abstract

Objectives Hybrid aortic arch repair procedure was introduced to reduce invasiveness in high-risk patients with aortic arch pathology. The good results are expanding its application, but endoleak, particularly type I, remains its Achilles’ heel. Design We describe our experience with hybrid treatment of aortic arch diseases focussing on techniques and results to avoid type I endoleak. Materials and Methods A total of 15 high-risk patients with zone 0–2 aortic arch pathology underwent supra-aortic debranching on ascending aorta and proximal aortic arch reinforcement with a Dacron prosthesis. Metachronously, the procedure was completed with endovascular stent grafting (ESG). Results Median age was 70 years with a mean European System for Cardiac Operative Risk Evaluation (EuroSCORE) of 12.7 ± 6.8. One patient died between aortic debranching and ESG. Mean time between surgical debranching and ESG was 32 ± 27.7 days. No major neurological events occurred. Mean length of the landing zone for ESG was 3.8 ± 0.8 cm. Computed tomography (CT) angiography scan performed soon after operation, and at 3, 6, and 12 months did not show any type I endoleak. Conclusions Supra-aortic debranching on ascending aorta with proximal aortic arch reinforcement is a useful step to ensure a safe landing zone for ESG, reducing risk early to midterm of endoleak. Longer term follow-up is required to confirm the viability of this technique.