[Surgical strategy for extended aortic arch aneurysm].

The management of an extended aortic arch aneurysm still remains a clinical challenge. Open surgery can be invasive for the patients with comorbidities. Since thoracic endovascular aneurysm repair (TEVAR) was introduced, hybrid therapy has been applied for the extended arch aneurysm. From 1997 to 2013, 379 patients have undergone aortic arch surgery. Of those, 241 patients of non-dissection aneurysm were studied. Open surgical repair with L-shaped thoracotomy was done in 28 patients, frozen elephant trunk( FET) in 30 patients, long elephant trunk( LET) with 2nd TEVAR in 21 patients, debranched TEVAR in 10 patients and standard arch grafting in 152 patients as a control group. The brain infarction rate was high in debranched TEVAR (40%) and L-shaped group (25%). The paraplegia rate was high in FET group( 23.3%). The respiratory failure rate was high in the L-shaped group and the LET group. In-hospital mortality was 0.0% in the L-shaped group, 6.7% in the FET group, 4.8% in the LET group, 20% in the debranched group and 0.7% in the control group. The debranched TEVAR group is our early experience, and the recent outcomes of this procedure have improved. The management of extended aortic arch aneurysm has changed with hybrid approach combined with TEVAR. Open repair is still the gold standard, but hybrid therapy is used for high-risk patients. Off-pump debranched TEVAR tends to be applied for extended arch aneurysm.