Hybrid repair of type A acute aortic dissections with the Lupiae technique: Ten-year results

Abstract

Replacing the ascending aorta and the arch in patients with type A acute aortic dissection achieves good short-term results, but several patients are left with distal intimal tears or a patent false lumen in the descending aorta. In this series, we report the 10-year experience with the Lupiae technique, a hybrid aortic repair technique for patients with type A acute aortic dissection. From 2003 to 2013, 89 patients with type A acute aortic dissections underwent replacement of the ascending aorta, the arch, and the rerouting of the neck vessels on the ascending aorta, creating a proximal Dacron landing zone for a completion with thoracic endovascular aortic repair if necessary. In-hospital mortality was 8.9%. In 16 patients, the false lumen healed spontaneously, whereas the remaining 65 patients underwent thoracic endovascular aortic repair. One patient died after thoracic endovascular aortic repair. Eighty patients were followed up. Complete thrombosis of the false lumen was obtained in 93.8% of patients. The median follow-up was 46 ± 35 months. Overall 8-year survival was 93.7% ± 5%, 100% for patients with spontaneously healed residual false lumen after just type A acute aortic dissection repair and 92.3% ± 7.7% for patients who underwent thoracic endovascular aortic repair after type A acute aortic dissection repair. In 10 years, 1 patient underwent a reoperation on the distal aorta (1.25%). The availability of a Dacron landing zone on the distal ascending aorta after type A acute aortic dissection repair allows the exclusion, with a thoracic endovascular aortic repair, of any residual intimal tear refilling a patent false lumen. This approach seems to be associated with a high probability of false lumen thrombosis and low rates of reoperations on the distal aorta.