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Hybrid Repair of Thoracic and Thoraco-Abdominal Aortic Aneurysms: 10 Year, Single Surgeon Experience in 158 Patients
Giampiero Esposito, Davide Patrini, Samuele Bichi, Camillo Poloni, Pasquale Pellegrino, Marianna Redaelli, Giuseppe Nicola Valerio, Vincenzo Arena.
Humanitas Gavazzeni Hospital - Bergamo, Bergamo, Italy.

HYBRID REPAIR OF THORACIC AND THORACO-ABDOMINAL AORTIC ANEURYSMS: 10-YEAR, SINGLE SURGEON EXPERIENCE IN 158 PATIENTS.
Objective: Hybrid approach to thoracic and thoracoabdominal aortic aneurysm may improve the morbidity and mortality in patients who are suboptimal candidates for conventional open surgery.
The aim of this study was to analyze retrospectively a 10-year single surgeon experience in the hybrid treatment of aneurismal aortic disease of different extent and etiology.
Methods: We carried out a retrospective review of 158 patients treated from November 2002 to November 2012 by a single surgeon (Dr. G. Esposito) requiring off-pump surgical rerouting of supraaortic vessels +/- visceral vessels from the undiseased ascending aorta ( 36 pts) or an on-pump rerouting of supraaortic vessels +/- visceral vessels from a replaced ascending aorta (108 pts). In 15 pts with mega-aortic syndrome involving also the abdominal aorta a surgical two-stage approach was performed firstly with on-pump ascending aorta replacement plus epiaortic vessels rerouting, secondly an off-pump abdominal aorta replacement plus visceral vessels rerouting was done to create a proximal and distal landing zone for subsequent endograft implantation. The endovascular procedure has been performed in 130 of 145 survived patients (89.6%) in order to cover the remaining diseased aorta. The etiology of the aortic aneurysm was type A acute dissection in 68 pts, chronic dissection in 39 pts, degenerative aneurismal dilatation in 51 pts.
Results: The 30-day mortality rates was 13/158 (8,2%), the incidence of temporary renal failure was 5,2%. None of the patients had stroke or spinal chord injury. Mean follow-up was 72 months (range 2-120) and the survival rate was 87%. The endoleak’s rate was 3/145 (2%).
Conclusion: Hybrid staged surgical and endovascular therapy represent a good alternative option in the treatment of diffuse aneurysmal dilatation involving the thoracic and thoraco-abdominal aorta at different extent especially in high-risk patients and urgent/emergent cases. The outcome of these patients is strictly dependent from aortic anatomy, comorbid status and age. In this single surgeon experience the hybrid staged aortic repair seems to offer a safe alternative treatment to conventional surgery showing good long- term results.


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