Analysis of clinical outcomes of one-staged hybrid procedure without thoracotomy for aorta lesion involving distal aortic arch.

BACKGROUND

This study aimed to evaluate the clinical outcomes of one-staged hybrid procedure for aortic lesions involving the distal aortic arch.

METHODS

We retrospectively studied 99 consecutive patients who underwent the hybrid procedure (thoracic endovascular aortic repair combined with supra-arch branch vessel bypass) in our center between April 2009 and January 2020 for lesions involving the distal aortic arch.

RESULTS

Median age was 64.0 (57.0-69.0) years, and 83 (83.8%) patients were male. There were five deaths in the perioperative period (three due to cerebral infarction and two due to intimal rupture). During the median follow-up of 41.0 months, 20 patients died, three had endoleak, one had a newly formed intimal tear, and two had femoral artery pseudoaneurysm. The 5- and 10-year survival rates of the total population were 72.2% and 48.8%, respectively. Additionally, there was no difference in the 5-year survival rate among the four groups according to different pathologies (Type B aortic dissection, aortic ulcer, aortic aneurysm, aortic pseudoaneurysm: 74.7%, 78.2%, 61.1%, and 75.5%, respectively, p = .58). Furthermore, there was no difference in the 5- and 10-year survival rates between the two groups according to the different bypass methods (right axillary artery [RAA]-left axillary artery [LAA] vs. RAA-LAA-left common carotid artery: 74.1% vs. 68.9%, p = .38).

CONCLUSIONS

Although one-staged hybrid procedure has fewer complications in high-risk patients with lesions involving the distal aortic arch, the long-term survival rate is not optimistic.