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OBJECTIVE: We report the results of a single center experience of treating thoracic aortic disease with extra-anatomic bypass and thoracic endovascular aortic repair (TEVAR).
METHODS: Thirty patients with thoracic aortic disease who underwent hybrid procedure were retrospectively reviewed. Mean age was 63.97±14.07 (range 30 to 85) and female was 17.2%. The distribution of pathologies included aneurysm (20, 66.6%), and dissection (10, 33.4%) including 2 acute aortic dissection. Two patients were diagnosed as Marfan syndrome and 3 as Behcet’s disease. Preoperative risk factors included CAOD (n=12, 40%), PAOD (n=6, 20%) and renal failure (n=5, 16.7%). Mean logistic EuroSCORE was 16.7 ± 13.7 (4.7~62.9). Intra-thoracic debranching of the innominate and common carotid artery was performed in 22 patients (73.3%) and remaining 8 patients underwent extra-thoracic bypass. Staged procedure underwent in 27 patients and simultaneous procedure surgery followed by stent insertion in hybrid OR underwent in 3 patients.
RESULTS: Stroke developed in 4 patients (13.3%) and overall in-hospital mortality either after surgery or TEVAR was 6.4% (n=2). Endoleak was observed in 9 patients (29.0%) after endovascular repair. Mean follow up duration was 16.8±17.4 months (range 3 to 63). During follow up, there was no aortic-related death and Kaplan-Meier estimates of survival were 85.0±7.0% after 48months. In 6 patients (75%) among 8 dissection patients, complete thrombosis in false lumen was found. Free from re-intervention or re-operation at 48 months was 88.4±7.8%.
CONCLUSIONS: Mid-term results of hybrid treatment of endovascular repair and surgery for patients with thoracic aortic disease are tolerable and revealed the treatment is useful and safe for high-risked patients.