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Hybrid Arch Repair With Zone 0 Stenting In Patients With Extensive Aortic Pathology
Jeffrey A. Zucker, Joshua R. Chen, Vishal Shah, DO, Colin King, PA-C, Jacqueline McGee, CRNP, Babak Abai, MD, Konstadinos Plestis, MD;
Thomas Jefferson University, Philadelphia, PA, USA
Background: Open total arch repair (TAR) in patients with aortic disease involving the distal arch and descending aorta has been associated with severe morbidity and mortality. Advancements in minimally invasive aortic surgery and the advent of hybrid arch repair (HAR) now offer previously poor surgical candidates a viable treatment option. We present our outcomes of HAR in patients deemed too high-risk for open arch repair for distal aortic arch pathology.
Methods: We performed a retrospective review of a prospectively maintained aortic database. The patients were retrospectively evaluated for demographics, disease etiology, comorbidities, preoperative imaging, technical success, postoperative complications, length of hospital stay, and mid-term outcomes
Results: From 2011 to 2023, 15 patients (72.7 ± 10.2 years) underwent total HAR repair. The most common etiology of aortic disease was aneurysmal degeneration (53.3%) followed by chronic type B dissection (20.0%). All patients underwent single-stage total arch debranching with zone 0 reimplantation with 100% technical success. In hospital mortality was 20% with all patients being aged 80 or older. Additionally, 2 (13.3%) patients developing retrograde type A dissection while in the hospital. The average length of hospital stay was 14.3 ± 11.4 days with patients spending 6.6 ± 5.69 of those days in the ICU. Post-operative stroke was seen in 1 (6.7%) patient. No transient ischemic attacks, spinal cord injuries, or reoperations for bleeding or endoleak were observed. The average duration of follow up was 1380 days. Mid-term follow-up demonstrated no reintervention, endoleak in 3 (20%) patients and 8 (53.3%) patient deaths.
Conclusions: Our experience has shown that HAR is a suitable alternative to TAR in patients considered too high-risk for operative intervention. Careful pre-operative selection is necessary to minimize mortality. Further studies looking at long-term outcomes are still needed.
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