Midterm Outcomes of Carotid-to-Carotid Bypass for Hybrid Treatment of Aortic Arch Disease

Abstract

The purpose of this study was to compare midterm results of carotid-to-carotid bypass (CCB) after hybrid repair of aortic arch disease. Between October 2001 and April 2012, all patients undergoing hybrid aortic arch repair with CCB were enrolled. CCBs were positioned in the subcutaneous or in the retropharyngeal position. Hybrid aortic arch repair was performed in a single-stage intervention. We treated 19 (82.6%) men and 4 women; mean age was 74 ± 6 years (range, 58-83 years). Subcutaneous tunnelization was performed in 15 (65.5%) cases and the retropharyngeal route in 8 (34.5%). In-hospital mortality was 8.7% (n = 2); causes of death were major stroke (n = 1) and respiratory failure (n = 1). Cranial nerve injuries (transient or permanent), dysphagia, or local problems were not observed. Tracheostomy was never required. Early outcomes did not differ between the 2 types of bypass. Mean follow-up was 44 months (range, 1-118; median 24). Survival rate at 1, 3, and 5 years was 70% ± 9.6%, 55% ± 10.7%, and 50% ± 11.1%, respectively. At the time of the last follow-up control, all bypasses were patent: stenosis and thrombosis were not recorded. Bypass graft or endograft infection were not registered. Shrinkage of the aortic lesion was observed in 15 (71.4%) cases. CCBs are durable at midterm follow-up. No relevant superiority was identified between the 2 types of CCB; subcutaneous and retropharyngeal routes proved to be equally safe.