HYBRID AORTIC ARCH SURGERY TO CREATE A LANDING ZONE IN THE ASCENDING AORTA

Authors

  • António Cruz Tomás Serviço de Cirurgia Cardiotorácica do Hospital de Santa Marta https://orcid.org/0000-0002-9144-2669
  • Álvaro Laranjeira Santos Serviço de Cirurgia Cardiotorácica do Hospital de Santa Marta
  • Jorge Pinheiro Santos Serviço de Cirurgia Cardiotorácica do Hospital de Santa Marta
  • Daniela Varela-Afonso Serviço de Cirurgia Cardiotorácica do Hospital de Santa Marta
  • José Fragata Serviço de Cirurgia Cardiotorácica do Hospital de Santa Marta

DOI:

https://doi.org/10.48729/pjctvs.219

Abstract

Introduction: Thoracic Endovascular Aortic Repair (TEVAR) has enabled the treatment of aortic pathology that previously required open surgery, with higher morbidity and mortality. The need for a favorable landing zone (Lz), without compromising the patency of the supra-aortic vessels meant that Ishimaru Lz 2 was the most proximal technically feasible Lz. We developed a hybrid technique for the creation of a more proximal Lz in high risk patients - in the first stage, debranching/ rerouting of the supra-aortic vessels, with or without ascending aorta replacement, was performed; a few weeks later, a TEVAR with a LZ in the distal ascending aorta was performed. This technique allowed the avoidance of the more aggressive total arch and proximal descending aorta replacement (Elephant Trunk or Frozen Elephant Trunk - FET) in high risk patients.

We reviewed all patients who underwent hybrid arch surgery in our Department to create a more proximal Lz that allowed safe TEVAR stent placement.

From November 2007 to October 2019, 15 patients required hybrid surgery to achieve treatment - 9 by replacing the ascending aorta and debranching supra-aortic vessels and 6 by debranching and re-routing supra-aortic vessels to the native ascending aorta. All underwent computed tomography angiography within 30 days of surgery and had follow-up with annual appointments and imaging control.

Patients’ average age was 65.5 (+/- 11.5) years, 73.3% being male. Average follow-up was 54.7 (+/- 46.2) months. The most common diagnosis was thoracic aortic aneurysm (66.7%), followed by chronic type B aortic dissection (20.0%), pen- etrating atherosclerotic ulcer (6.7%) and reintervention due to endoleak (EL, 6.7%). No in-hospital mortality was registered. ICU and hospital stay was 1.3 (0.8) days and 9.8 (10.3) days, respectively. Survival at 1- and 5- years was 84.6% and 65.8%, respectively. No EL was detected in 66.7% (n=10) of patients. Incidence of early EL was 20.0% (n=3), of which two-thirds had spontaneous resolution, and late EL was 13.3% (n=2). Endovascular reintervention was required in one patient.

TEVAR in the context of hybrid surgery is associated with low morbidity and mortality, with a low incidence of EL and good early and long term survival.

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References

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Published

04-01-2022

How to Cite

1.
Cruz Tomás A, Laranjeira Santos Álvaro, Pinheiro Santos J, Varela-Afonso D, Fragata J. HYBRID AORTIC ARCH SURGERY TO CREATE A LANDING ZONE IN THE ASCENDING AORTA. Rev Port Cir Cardiotorac Vasc [Internet]. 2022 Jan. 4 [cited 2022 Jan. 28];28(4):21-4. Available from: https://pjctvs.com/index.php/journal/article/view/219

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