One-stage hybrid procedure for distal aortic arch disease: mid-term experience at a single center

Su-Wei Chen; Yong-Liang Zhong; Zhi-Yu Qiao; Cheng-Nan Li; Yi-Peng Ge; Rui-Dong Qi; Hai-Ou Hu; Li-Zhong Sun; Jun-Ming Zhu

doi:10.21037/jtd-20-2338

One-stage hybrid procedure for distal aortic arch disease: mid-term experience at a single center

J Thorac Dis. 2020 Dec;12(12):7117-7126. doi: 10.21037/jtd-20-2338.

Authors

Su-Wei Chen¹, Yong-Liang Zhong¹, Zhi-Yu Qiao¹, Cheng-Nan Li¹, Yi-Peng Ge¹, Rui-Dong Qi¹, Hai-Ou Hu¹, Li-Zhong Sun¹, Jun-Ming Zhu¹

Affiliation

¹ Department of Cardiovascular Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing Aortic Disease Center, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing Engineering Research Center of Vascular Prostheses, Beijing, China.

Abstract

Background: This study analyzes the outcomes of a one-stage hybrid procedure combining thoracic endovascular aortic repair (TEVAR) with extra-anatomic bypass in patients with distal aortic arch disease.

Methods: This retrospective study collected 103 hybrid procedures combining TEVAR with extra-anatomic bypass (mean age, 62.2±9.3 years; 90 males) performed from January 2009 to January 2019 at Beijing Anzhen Hospital. We analyzed 30-day and mid-term outcomes including survival rate and the incidence of stroke, spinal cord injury (SCI), and endoleak.

Results: Five deaths (4.6%) occurred within 30 days, including type I endoleak in Zone 1 (n=1), hemorrhagic shock (n=1), stroke (n=2), and stent migration (n=1). Two patients developed SCI. The median follow-up time was 39.5 (interquartile range, 13.6-69.0) months. In all, 14 late deaths occurred; these were due to stroke (n=2), severe pneumonia (n=1), aortic rupture caused by type I endoleak (n=3), and sudden death (n=8). Six late endoleaks occurred including three type I and one type II in Zone 1 and two type I in Zone 2. In a competing risks analysis, the incidences of reintervention at 7 years, late death, and survival without reintervention were 8%, 22%, and 70%, respectively. In a Cox risk model, stroke (HR, 21.602; 95% CI: 2.798-166.796; P=0.003) was the only risk factor for 30-day mortality. Stroke (HR, 19.484; 95% CI: 5.245-72.380; P<0.001), SCI (HR, 15.548; 95% CI: 2.754-87.786; P=0.002), and endoleak (HR, 4.626; 95% CI: 1.068-20.040; P=0.041) were independent risk factors for long-term mortality.

Conclusions: The one-stage hybrid procedure provides acceptable mid-term results with good mid-term patency of extra-anatomic bypass. Strict selection of patients suitable for hybrid repair can effectively improve the survival rate and reduce the incidence of complications. At the same time, close follow-up patients should receive close long-term follow-up after hybrid procedure.

Keywords: Hybrid; distal aortic arch; extra-anatomic bypass; thoracic endovascular aortic repair (TEVAR).