Abstract
ObjectiveTo investigate whether hybrid repair has supremacy over conventional open repair in aortic arch diseases.MethodsA comprehensive search was undertaken in two major databases (PubMed and MEDLINE) to identify all studies comparing the two surgical techniques in five years, up to December 2018, that met the established criteria in this study. The search returned 310 papers, and 305 were selected after removing duplicates. The abstracts of the remaining articles were assessed, resulting in 15 studies that went to full-text analysis. After application of the inclusion and exclusion criteria, 8 papers remained for the final revision.ResultsEight studies met the criteria, with the inclusion of 1,837 patients. From a short-term perspective, hybrid repair and conventional open repair had similar outcomes in terms of postoperative mortality and acute neurological events. Hybrid repair was associated with less respiratory complications and risk of new intervention, as well as reduced hospital length of stay. Conventional open repair showed better mid- and long-term outcomes.ConclusionHybrid repair should be used in selected patients, with a high risk or very high-risk profile for conventional surgery. Finally, since most of the current data were obtained from limited to large samples, with narrow follow-up and had great heterogeneity, the best approach to the aortic arch is still variable. Therefore, the decision of the approach should be individualized and evaluated by the whole Heart Team, considering the expertise of the surgical team.
Highlights
Complex thoracic aortic diseases (CTAD) are considered a spectrum of diseases that involve the ascending aorta, the aortic arch and descending portions of the aorta and present themselves as a challenge to conventional surgical cardiovascular therapy[1].Historically, surgical repair of CTAD started with a complete invasive approach, with access through wide-open thoracotomy, use of a synthetic prosthesis to replace all the diseased portion of aorta and reconstruction of the great vessels, in a technique known as complete open aortic arch repair[1]
Surgical repair of CTAD started with a complete invasive approach, with access through wide-open thoracotomy, use of a synthetic prosthesis to replace all the diseased portion of aorta and reconstruction of the great vessels, in a technique known as complete open aortic arch repair[1]
Ribeiro TS, et al - Approaches for Aortic Arch Disease: a Review the procedure is related to high morbidity and mortality and numerous complications, mainly due to prolonged cardiopulmonary bypass (CPB) time and/or hypothermic circulatory arrest (HCA), a condition required to reduce brain tissue damage and multiorgan ischemia and that can have a direct impact on postoperative neurological outcomes[2]
Summary
Complex thoracic aortic diseases (CTAD) are considered a spectrum of diseases that involve the ascending aorta, the aortic arch and descending portions of the aorta and present themselves as a challenge to conventional surgical cardiovascular therapy[1]. Surgical repair of CTAD started with a complete invasive approach, with access through wide-open thoracotomy, use of a synthetic prosthesis to replace all the diseased portion of aorta and reconstruction of the great vessels, in a technique known as complete open aortic arch repair[1]. In the last two decades, with the improvement of much less invasive techniques, endovascular repair of the thoracic aorta appeared as an alternative with more desirable outcomes[3] and marked decrease in morbidity[4]
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