Hybrid aortic arch repair: The ultimate solution or a stop along the way to a total endovascular arch reconstruction?

Abstract

In their article in this issue of The Journal, Faure and colleagues 1 report their single-center experience with hybrid repair of chronic dissection-related aortic arch aneurysms. They combined aortic great vessel debranching with thoracic endovascular aortic repair to address the aortic arch pathology completely. In this series of 33 patients, there were no in-hospital deaths. At a respectable mean follow-up of 20 months, the overall mortality was 12% at last follow-up. Therewas a 24% incidence of endoleak overall, and 8 patients required some form of major reintervention, not all of which were for endoleak. Given this high-risk group of patients, Faure and colleagues 1 are to be commended on their excellent outcomes. Surgical treatments to address aortic arch pathology traditionally have involved open techniques of total arch replacement with circulatory arrest and reimplantation of the great arteries. Even in a high-risk patient population, excellent results can be achieved, and many centers continue to advocate this open surgical approach as the criterion standard. 2 The rapid expansion of thoracic endovascular technology in the past 15 years, however, is transforming traditional open repair paradigms. Furthermore, innovative hybrid repair approaches, such as those described by Faure and colleagues, 1 with a combination of open and endovascular techniques, have expanded the risk profile of patients and scope of aortic pathologies amenable to surgical therapies. 3-6 With continued evolution in this field, we need to reassess critically the current status of surgical options for treating aortic arch pathologies. It is also imperative that we seek collaborative approaches to studying aortic arch aneurysm