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Objectives:
Over the last decade, hybrid operations combining open and endovascular techniques have evolved as less-invasive treatment strategies for patients with complex aortic and co-existing cardiovascular disease. The aim of this study is to describe repair techniques and assess outcomes in patients undergoing hybrid repair for thoracic aneurysms presenting after previous coarctation repair.
Methods:
From 2004-2011, 13 patients underwent hybrid repair of coarctation of aorta by Elephant trunk with endovascular completion(n=5), Frozen elephant trunk(n=7), or antegrade stent grafting (n=1) either with(n=12) or without(n=1) deep hypothermic circulatory arrest. The mean age at surgery was 45 ± 13.5 years. Eight out of thirteen patients underwent supraaortic arterial revascularization either as ascending to subclavian bypass (n=5), carotid-subclavian bypass(n=2), or ascending to carotid and subclavian bypass (n=1). 10 patients had a bicuspid aortic valve, 5 of which underwent concomitant aortic valve replacement and 1 aortic valve repair for significant valve dysfunction. Four patients had a hypoplastic arch. Other procedures included: ascending aortic repair(n=4), CABG(n=1), ascending to descending bypass(n=1), and subclavian artery aneurysm repair(n=1). One operation was performed as an emergency, the others were elective. Mean maximum aneurysm diameter was 5.9±1.5cm. Data was obtained from prospective database and chart review.
Results:
There was no perioperative mortality, no stroke, renal failure or paraplegia. One patient required prolonged intubation for respiratory distress, while another required reoperation for post-op bleeding. Three patients developed type II endoleaks, two of which required re-intervention. Mean length of hospital stay was 9±5.5 days. There has been one late death due to hypertensive crisis and associated DIC. All patients were asymptomatic post repair. At mean follow-up of 5 months, there has been no aortic growth and diameter has decreased to 5.5±1.8cm.
Conclusion:
Hybrid repair of post-coarctation repair aneurysm is a safe and effective less-invasive treatment option for patients with complex morphology or concomitant cardiac disease.