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Hybrid Debranching Procedure Without Cardiopulmnonary Bypass For Treating Aortic Arch Aneurysm
Christos Tourmousoglou, Sr.1, Socrates Sismanidis
2, Dimitrios Chatzis
2, Evanggelia Samara
2, George Grammatikos
2, Stavros Siminelakis
2;
1St Lukes Hospital, tHESSALONIKI, Greece,
2IOANNINA, IOANNINA, Greece
Background: The treatment of aortic arch aneurysms is a challenge. Open total arch surgery, with complex circulatory management and cerebral protection, is sometimes prohibitive for patients with multiple comorbidities who experience significant neurologic and cardiovascular complications.Alternative therapies are implemented (or applied) for high-risk patients. Thoracic endovascular repair (TEVAR) has been used for stenting the aortic arch with open great vessel debranching.
Methods: Three patients were operated with this technique. Two males (A.B) and one female(C). Patient A with aortic arch aneurysm was operated first with debranching with a bifurcated graft. The trunk of graft was anastomosed on the ascending aorta, one limb of the graft was anastomosed with innominate artery and the other limb with the left subclavian stump and the left carotid stump.After 6 days the stenting of arch was done distally of the take off of the debranching. Patient B with arch aneurysm was operated with debranching of the three arch vessels with a bifurcated graft and stenting of arch simultaneously as in patient A. Patient C with arch aneurysm and ascending aorta aneurysm was operated with ascending aorta replacement and debranching of the arch vessels (innominate artery and left carotid artery).
Results: Patient A was admitted again with dissection of ascending aorta after 1 year and he was operated but he died in the OR. Patient B had an uneventful recovery. Patient C had also an uneventful recovery.
Conclusion: This hybrid aortic arch repair might be an attractive option for complex pathologies of the aortic arch. The combination of these two techniques limit operative,bypass time and can be performed without CPB. The hybrid approach for aortic arch aneurysms could be performed with acceptable mortality and less postoperative and long-term endoleak rate.
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