Hybrid Repair Research Articles

Hybrid repair of complicated acute aortic arch intramural haematoma with the Castor single-branch stent graft.

We report the off-label application of the Castor single-branch stent graft for a complicated acute intramural haematoma involving the aortic arch. The endograft was deployed in zone 1 with the single branch in the left common carotid artery through a surgical left carotid and percutaneous right femoral artery access. The procedure was completed with the construction of a left carotid-subclavian bypass followed by plug embolization of the left subclavian artery.

Hybrid Surgical treatment of thoraco-abdominal aneurysm: case report

The conventional surgical treatment of TAAA is complex and is associated with important perioperative mortality and mobidity. There is consensus that endovascular aneurysm repair (EVAR) is the preferred treatment for high-risk patients, but the availability of endovascular-branched grafts are quite limited. As an alternative for such dilema, the hybrid approach came as another possibility for high risk patients where totally endovascular treatment is not feasible and clinical condition for convencional surgery is prohibitive. Thus, the objective of this study is to report our service's experience with the hybrid surgical technique for treatment of this severe condition. Male patient, 73 years old, diagnosed with fusiform aortic aneurysm at the thoracoabdominal transition level, measuring 10.1 x 8.9 cm, associated with a large retroperitoneal hematoma, likely corresponding to an aneurysm rupture. The hybrid strategy was chosen, involving two stages: conventional surgery and endovascular procedures. However, approximately 24 hours after the first surgery the patient had refractory cardiac arrest at intensive care unit. Surgical treatment of thoracoabdominal aneurysm is a complex issue, and the trend over time is tending toward total endovascular treatment, and these devices will undoubtedly evolve and be used more and more in the years to come. However, the hybrid repair will likely remain a standard procedure for a while, until total endovascular procedures become more common and the necessary endovascular materials widely available.

Urgent hybrid repair of a symptomatic dissection-related type ii thoracoabdominal aortic aneurysms.

Emergency repair of type II thoraco-abdominal aortic aneurysms is burdened by high perioperative morbidity and mortality. We report the case of a symptomatic type II post-dissection thoraco-abdominal aortic aneurysm that was treated by mean of a hybrid technique. The repair was carried out through two stages. In the first stage, we deployed two imbricated stent grafts in the descending thoracic aorta. A left carotid to left subclavian artery by-pass was preemptively performed in order to obtain a proper proximal landing zone and as part of the spinal cord protective maneuvers. The endovascular first stage was effective in obtaining proximal sealing but, as expected, did not prevent distal reperfusion of the aneurysmatic false lumen. Few hours later, we moved on to the second stage in which we repaired the aneurysmal distal thoracic and abdominal aortic segment by mean of a multibranched synthetic graft. The repair was carried out through a left thoracophrenolaparotomy in the VII intercostal space. A left passive arterial by-pass and selective cold renal and warm visceral perfusion were adopted in order to provide organ protection. Technical success was achieved and radiologically confirmed. The patient experienced a mild postoperative paraplegia, which almost completely regressed after a neuro-motor rehabilitation program.

Zone Zero Hybrid Repair of the Thoracic Rupture of a False Lumen in Non-A Non-B Aortic Dissection

Zone Zero Hybrid Repair of the Thoracic Rupture of a False Lumen in Non-A Non-B Aortic Dissection

Modified Ex Vivo Renal Reconstruction to Facilitate Fenestrated-Branched Endovascular Repair of a Thoracoabdominal Aortic Aneurysm.

To report the use of modified ex vivo renal artery (RA) reconstruction in a patient with 2 small right RAs (RRAs) in anticipation of planned fenestrated-branched endovascular aortic repair (FB-EVAR) of thoracoabdominal aortic aneurysm (TAAA). A staged hybrid repair was utilized in a patient with Extent II TAAA involving celiac axis (CA), superior mesenteric artery (SMA), single left RA (LRA), and 2 small (<3 mm) RRAs. The first-stage operation consisted of hepato-renal bypass using modified ex vivo renal reconstruction with single end-to-end anastomosis to both RAs using a saphenous vein graft. A second stage FB-EVAR was performed using patient-specific manufactured stent-graft with 3 fenestrations for the CA, SMA, and LRA 6 weeks later. The patient recovered with no complications. At 4 years, the patient had widely patent hepato-renal bypass and target vessels with normal renal function. The use of adjunctive hybrid procedures may optimize or facilitate FB-EVAR. In this patient, salvage of 2 small RAs was not ideally suited for branch stenting but was possible using modified ex vivo RA reconstruction with preservation of kidney parenchyma and function. This case report illustrates a hybrid approach to overcome one of the most frequent limitations to total endovascular incorporation of renal arteries, eg small diameter, early bifurcation and multiple vessels. The modified ex vivo technique allows meticulous renal artery reconstruction without the deleterious effect of warm ischemia and without the cumbersome reconstruction of ureter and vein that is needed with traditional on table ex vivo auto transplantation. The technique is used in a minority of cases and adds the morbidity of open approach. Case selection is of paramount importance.

Variability in the Treatment of High-Risk Type B Aortic Dissection at a Single Center

Although there are established high-risk features in acute Type B aortic dissection (TBAD), its management is variable. This study characterizes complicated, uncomplicated, and high-risk TBAD in addition to their management and outcomes to gain insight into the actual significance of these high-risk features and the reality of real-world practice in managing TBAD. A retrospective review of 62 patients was conducted. Patient demographics, management, and outcomes were characterized and evaluated with Pearson's χ 2 test, Fisher's exact test, or analysis of variance (ANOVA). Of the 32 high-risk TBADs, 66% (n=21) received endovascular repair, 31% (n=10) were medically managed, and 3% (n=1) received hybrid (open and endovascular) repair. Refractory hypertension and pain (52%, n=11) were the most common high-risk features in patients with high-risk TBAD that received endovascular repair. A maximum aortic diameter of > 40 mm (67%, n=6) was the most common high-risk feature in patients that received medical management. The most prevalent high-risk feature for all treatment groups in the high-risk TBADs was an aortic diameter of > 40 mm (n=16; 50%). Adverse post-operative outcomes were highest in the high-risk and complicated groups with endoleak as the most common adverse outcome (high-risk 12.9%, complicated 13.6%). Among the 62 patients, 47% (n=26) had follow-up since their admission with an average follow-up time of 69 ± 166 days. The significance of high-risk features in management of high-risk TBAD remains unclear. This single-center experience with managing acute TBAD reveals the reality of inadequate follow-up that may be specific to this disease process. This highlights a need to direct more efforts to assess long-term outcomes after treatment.

Hybrid intraperitoneal onlay mesh repair for incisional hernias: a systematic review and meta-analysis.

Laparoscopic IPOM is technically challenging, especially regarding fascial closure. Hybrid repair has been proposed as a simpler approach. We aimed to compare hybrid and laparoscopic intraperitoneal onlay mesh repair (IPOM) in patients undergoing ventral hernia repair (VHR). We performed a systematic review of Cochrane, Scopus, and MEDLINE databases to identify studies comparing hybrid versus laparoscopic IPOM VHR reporting the outcomes of recurrence, mortality, seroma, postoperative complications, reoperation, surgical site infection, and operative time. Statistical analysis was performed using RStudio 4.1.2 using a random-effects model. We screened 2,896 articles and fully reviewed 22 of them. A total of five studies, encompassing 664 patients were included. Among them, 337 (50.8%) underwent laparoscopic IPOM. All patients had incisional hernias, with a mean diameter varying from 3 to 12.7cm, 60% were women, with a mean BMI varying from 29.5 to 38. The hybrid approach had a lower rate of seroma when compared to the laparoscopic (OR 0.22; 95% CI 0.05 to 0.92; p = 0.038; I²=78%). We found no difference in recurrence, mortality, postoperative complications, reoperation, surgical site infection, and operative time between groups. Hybrid IPOM is a safe and effective method for incisional hernia repair. Moreover, it facilitates fascial defect closure and decreases postoperative seromas.

Open, endovascular or hybrid repair of aortic arch disease: narrative review of diverse strategies with diverse options.

The management of aortic arch disease is complex. Open surgical management continues to evolve, and the introduction of endovascular repair is revolutionizing aortic arch surgery. Although these innovative techniques have generated the opportunity for better outcomes in select patients, they have also introduced confusion and uncertainty regarding best practices. In New York, we developed a collaborative group, the New York Aortic Consortium, as a means of cross-linking knowledge and working together to better understand and treat aortic disease. In our meeting in May 2023, regional aortic experts and invited international experts discussed the contemporary management of aortic arch disease, differences in interpretation of the available literature and the integration of endovascular technology into disease management. We summarized the current state of aortic arch surgery in this review article. Approaches to aortic arch repair have evolved substantially, whether it be methods to reduce cerebral ischaemia, improve haemostasis, simplify future operations or expand options for high-risk patients with endovascular approaches. However, the transverse aortic arch remains challenging to repair. Among our collaborative group of cardiac/aortic surgeons, we discovered a wide disparity in our practice patterns and our management strategies of patients with aortic arch disease. It is important to build unique institutional expertise in the context of complex and evolving management of aortic arch disease with open surgery, endovascular repair and hybrid approaches, tailored to the risk profiles and anatomical specifics of individual patients.

Conservative treatment of retrograde aortic dissection after hybrid repair of aortic arch aneurysm.

Conservative treatment of retrograde aortic dissection after hybrid repair of aortic arch aneurysm.

Diameter and dissection of the abdominal aorta and the risk of distal aortic reoperation after surgery for type A aortic dissection

BackgroundSurgery for Stanford type A aortic dissection (TAAD) is associated with an increased risk of late aortic reoperations due to degeneration of the dissected aorta. MethodsThe subjects of this analysis were 990 TAAD patients who survived surgery for acute TAAD and had complete data on the diameter and dissection status of all aortic segments. ResultsAfter a mean follow-up of 4.2 ± 3.6 years, 60 patients underwent 85 distal aortic reoperations. Ten-year cumulative incidence of distal aortic reoperation was 9.6%. Multivariable competing risk analysis showed that the maximum preoperative diameter of the abdominal aorta (SHR 1.041, 95%CI 1.008–1.075), abdominal aorta dissection (SHR 2.133, 95%CI 1.156–3.937) and genetic syndromes (SHR 2.840, 95%CI 1.001–8.060) were independent predictors of distal aortic reoperation. Patients with a maximum diameter of the abdominal aorta >30 mm and/or abdominal aortic dissection had a cumulative incidence of 10-year distal aortic reoperation of 12.0% compared to 5.7% in those without these risk factors (adjusted SHR 2.076, 95%CI 1.062–4.060). ConclusionTAAD patients with genetic syndromes, and increased size and dissection of the abdominal aorta have an increased the risk of distal aortic reoperations. A policy of extensive surgical or hybrid primary aortic repair, completion endovascular procedures for aortic remodeling and tight surveillance may be justified in these patients.Trial registration:ClinicalTrials.gov Identifier: NCT04831073.

Two-staged hybrid repair of multiple great vessel and thoracic aneurysms with right vocal fold palsy using retrograde in situ branched stent grafting: a case report

BackgroundRepair of multiple thoracic aneurysms with vocal fold palsy represents a surgical challenge. Here, we present a case of multiple cervical and thoracic aortic aneurysms with right vocal fold palsy successfully treated with two-stage hybrid repair using retrograde in situ branched grafting.Case presentationA 52-year-old patient with multiple cervical and thoracic aortic aneurysms and right vocal fold palsy was treated using two-stage hybrid repair. Initially, the patient underwent an open partial arch replacement with reconstruction of the right subclavian, right common carotid, and left common carotid arteries. Three months after the initial procedure, the left subclavian artery was reconstructed during thoracic endovascular aortic repair with retrograde in situ stent grafting using the needle technique. The postoperative course was uneventful with no endoleaks detected using postoperative computed tomography.ConclusionThis case highlighted the potential of two-stage repair of multiple thoracic aneurysms using retrograde in situ stent grafting. With the expansion of surgical options to include endovascular and hybrid approaches, surgical procedures should be carefully planned for individuals with complex aortic diseases.

Arthroscopic Modified Double-Pulley Suture-Bridge Repair of Medium-Sized Supraspinatus Tendon Tears

At present, the repair patterns for medium-sized supraspinatus tendon tears are double- and single-row repairs. However, the limitations of double-row repair include excessive anchor implantation and incremental surgical cost and time, whereas a deficient tendon-bone contact area exists with single-row repair. The modified double-pulley suture-bridge repair presented in this study is an arthroscopic technique using 3 double-loaded suture anchors combined with a double-pulley technique to form a hybrid repair pattern with a double row as the mainstay and a single row as the supplement. In the treatment of medium-sized tendon tears, the modified double-pulley suture-bridge repair can not only maximize the tendon-bone contact area but also lower the surgical cost and shorten the operative time. The surgical technique is described, including pearls and pitfalls, as well as advantages and disadvantages.

Long Term Outcome After EndoVAC Hybrid Repair of Carotid Patch Infection

Long Term Outcome After EndoVAC Hybrid Repair of Carotid Patch Infection

Piezoelectric Actuator/Patch-Based Hybrid Repair and Fatigue Life Expansion of a Double-Edged Damaged Plate: An Analytical Approach and Numerical Validation

Piezoelectric Actuator/Patch-Based Hybrid Repair and Fatigue Life Expansion of a Double-Edged Damaged Plate: An Analytical Approach and Numerical Validation

Microwave joining of additive manufactured SS316 with conventional SS316 for hybrid structural applications

ABSTRACT Metal additive manufacturing (MAM) can better complement existing methods by providing hybrid structural strengthening and repair solutions. This opportunity and challenge can only be fulfilled by joining additive-manufactured (AM) parts with conventional ones. In this study, AM SS316 is joined with conventional SS316 through selective microwave hybrid heating. The SEM (scanning electron microscopy) images pointed towards non-epitaxial grain evolution along the joint interlayer due to the complete diffusion of Ni. EDS (energy dispersive spectroscopy) mapping exposed the intermixing of Fe from base metal to interlayer and Ni from interlayer to base metal. At the fusion zone, the maximum hardness of 282 HV was determined. Hard carbide phases attributed to increased hardness. A 378 MPa of ultimate tensile stress of weld signifies the exceptional bonding achieved between Ni-Fe. At last, the fractography study revealed both ductile and brittle modes of fracture.

Extending the range of bugs that automated program repair can handle

Modern automated program repair (APR) is well-tuned to finding and repairing bugs that introduce observable erroneous behavior to a program. However, a significant class of bugs does not lead to observable behavior (e.g., termination bugs and non-functional bugs). Such bugs can generally not be handled with current APR approaches, so complementary techniques are needed. To stimulate the systematic study of alternative approaches and hybrid combinations, we devise a novel bug classification system that enables methodical analysis of their bug detection power and bug repair capabilities. To demonstrate the benefits, we study the repair of termination bugs in sequential and concurrent programs. Our analysis shows that integrating dynamic APR with formal analysis techniques, such as termination provers and software model checkers, reduces complexity and improves the overall reliability of these repairs. We empirically investigate how well the hybrid approach can repair termination and performance bugs by experimenting with hybrids that integrate different APR approaches with termination provers and execution time monitors. Our findings indicate that hybrid repair holds promise for handling termination and performance bugs. However, the capability of the chosen tools and the completeness of the available correctness specification affects the quality of the patches that can be produced.

Hybrid repair of a thoracoabdominal aortic aneurysm in female patient with Loeys-Dietz syndrome

Hybrid repair of a thoracoabdominal aortic aneurysm in female patient with Loeys-Dietz syndrome

Management of complex thoracic aortic diseases with aberrant right subclavian artery.

We retrospectively evaluated early and intermediate outcomes of hybrid repair of complex thoracic aortic diseases involving an aberrant right subclavian artery. This paper aims to report features and available treatment options for this rare, hard-to-diagnose, and manage, aorta-related vascular condition. Between January 2012 and May 2019, 13 patients (mean age, 60.1 ± 9.3years; nine men) underwent complex thoracic aorta repair surgery. Six patients had a thoracic aortic aneurysm, two had type A aortic dissection, and five had complicated type B aortic dissection. Hybrid repair strategies included de-branching in combination with single-stage aortic arch replacement with the frozen elephant trunk technique performed in four patients, thoracic endovascular aortic repair in six patients, and 2-stage hybrid repair consisting of a total arch replacement with a conventional/frozen elephant trunk (first stage) and subsequent endovascular repair (second stage) in three patients. One early death occurred: a patient with acute type A aortic dissection, who underwent Bentall procedure and aortic arch replacement with the frozen elephant trunk technique, died in-hospital of multiorgan failure 41days after the procedure. The remaining 12 patients were discharged in stable condition. The median follow-up duration was 36months (2-71months). Two late mortalities occurred: a patient with residual type A aortic dissection, who underwent arch replacement with the frozen elephant trunk technique, died of intracranial hemorrhage 3months after the surgery. And 72years old female patient died of acute exacerbation of chronic obstructive pulmonary disease 2months after the surgery. Our study indicates that various hybrid strategies can be used to treat complex thoracic aortic diseases involving an aberrant right subclavian artery. The approach of choice depends on the features of disease pathology, the aortic segments involved, and the operating surgeon's experience.

Multicenter Comparison of Aortic Arch Aneurysms and Dissections Zone 0 Hybrid and Total Endovascular Repair.

Comparison of hybrid and total endovascular aortic arch repair at two tertiary vascular surgery centers. Consecutive patients undergoing hybrid (HG) or total endovascular (TEG) total aortic arch repair for aneurysms or dissections were included (2008-2022). Primary outcome measure was 30-day mortality. Secondary outcomes were major complications, technical success (defined as absence of surgical conversion/mortality, high-flow endoleaks or branch/limb occlusion), clinical success (defined as absence of disabling clinical sequelae), late and aortic-related mortality/reinterventions, freedom from endoleaks, aortic diameter growth > 5mm, graft migration and supra-aortic trunks (SAT) patency. In total, 30 patients were included, 17 in HG and 13 in TEG. TEG presented shorter intervention time (240.5 vs 341min, p = 0.01), median ICU stay (1 vs 4.5days, p < 0.01) and median length of stay (8 vs 17.5days, p < 0.01). No intraoperative deaths occurred. Technical success was 100%; clinical success was 70.6% in HG and 100% in TEG (p = 0.05). Thirty-day mortality was 13.3%, exclusively in HG (p = 0.11). Nine major complications occurred in 8 patients, 5 in HG and 3 in TEG (p = 0.99), among which five strokes, two in HG and three in TEG (p = 0.62). Late mortality was 38.5%, six patients in HG and four in TEG, p = 0.6. Two late aortic-related deaths occurred in HG (p = 0.9). Two aortic-related reinterventions, no graft migration or SAT occlusion was observed. Total endovascular repair seems to shorten operative times and provide higher clinical success compared with hybrid solutions, without significant 30-day mortality differences. The most common major complication is stroke.

The revascularization of the left subclavian artery with a cross over axilloaxillary bypass for the hybrid repair of thoracic aortic aneurysms

The revascularization of the left subclavian artery with a cross over axilloaxillary bypass for the hybrid repair of thoracic aortic aneurysms