Complications of Hybrid Management of the Aortic Arch: Our Experience

Purpose: Conventional treatment of aortic arch disease consists of open surgery using extracorporeal circulation and circulatory arrest in deep hypothermia. But in recent years, endovascular repair of the thoracic aorta has favored the treatment of aortic arch disease. Hybrid repair is a combination of revascularization of the supra aortic vessels and endovascular management of the aortic arch being a valid option for selected patients. We present the experience of our center in the hybrid treatment of dissection of the aortic arch. The morbidity and mortality at 30 days are described, referring to presurgical complications, presence of endoleaks, reinterventions, and bypass permeability.

Materials and Methods: We conducted a descriptive and prospective study of patients with a diagnosis of Stanford A aortic dissection with aortic arch involvement, DeBakey I, who underwent hybrid treatment between January 2017 to January 2019. All patients were treated electively.

Results: Of a total of 12 patients who had aortic arch involvement, 6 patients underwent conventional surgical treatment with aortic arch replacement with a frozen elephant trunk, and the other 6 (50%) underwent hybrid treatment. Five bypass aortic–brachiocephalic trunk–carotid procedures were performed, and one bypass aortic brachiocephalic trunk–carotid–left subclavian was performed followed by the release of the stent at the level 0 with usual technique. Supraaortic debranching was performed in patients (n = 6) through miniesternotomy. Endovascular technique was performed during the same surgical act as the debranching in three patients; three patients underwent hybrid surgery in two stages. Stent placement was performed retrograde through the femoral artery with fluoroscopic guidance. Computed tomography was performed after 6 months of the procedure. A 67% technical success was achieved. One patient (16%) presented with a femoral artery lesion during the extraction of the introducer, meriting polytetrafluoroethylene graft placement, and one patient (16%) presented with type I leak in the follow-up, so he required reintervention by releasing a new proximal stent. The 30-day mortality rate was 16% (n = 1), and the average follow-up period was 24 months. The overall mortality rate was 33% (n = 1). The permeability in the bypass was 100%, and there were no cases of neurologic injury or spinal ischemia.

Conclusions: Hybrid repair is a valid alternative in the treatment of arch disease in selected patients, with acceptable morbidity and mortality rates in medium term follow-up.