Aortic remodeling following hybrid arch repair with zone 0 to 5 thoracic endovascular aortic repairs for complex arch and descending thoracic aortic pathologies

Irbaz Hameed; Adham Ahmed; Stevan Pupovac; Naiem Nassiri; Roland Assi; Prashanth Vallabhajosyula

doi:10.1016/j.xjon.2023.12.004

Aortic remodeling following hybrid arch repair with zone 0 to 5 thoracic endovascular aortic repairs for complex arch and descending thoracic aortic pathologies

JTCVS Open. 2023 Dec 21:17:23-36. doi: 10.1016/j.xjon.2023.12.004. eCollection 2024 Feb.

Authors

Irbaz Hameed¹, Adham Ahmed¹, Stevan Pupovac¹, Naiem Nassiri², Roland Assi¹, Prashanth Vallabhajosyula¹

Affiliations

¹ Division of Cardiac Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Conn.
² Division of Vascular Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Conn.

Abstract

Objective: For high-risk patients with aortic arch pathology, hybrid aortic arch repair with simultaneous or staged thoracic endovascular repair of the descending aorta may be a viable alternative to open repair. However, data on postintervention aortic remodeling remain limited. We report the short-term outcomes of remodeling of the thoracoabdominal aorta after hybrid arch repair + thoracic endovascular repair.

Methods: All patients undergoing hybrid arch repair with planned zones 0 to 5 thoracic endovascular repair from January 2020 to March 2022 were retrospectively reviewed. Computed tomography angiography scans preoperatively, after hybrid aortic arch repair, and on long-term follow-up were analyzed for thoracoabdominal aorta remodeling. Mean change in aortic true luminal diameter and full luminal diameter was calculated at every level, and paired-samples t test was used to compare means.

Results: Of 39 patients, 38 had follow-up data at a mean duration of 14.9 months. There were a total of 3 (7.7%) deaths, 0 (0.0%) strokes, and 0 (0.0%) paralysis. For the 35 patients undergoing thoracic endovascular repair for aortic dissection, at follow-up, there was a significant increase in the mean true luminal diameter at each level (P < .05), except at the aortic bifurcation and common iliac arteries. The largest increase in mean true luminal diameter (P < .01) was observed at the level of the left inferior pulmonary vein (mean difference +13.22 mm, 95% CI, 10.38-16.07), tracheal carina (mean difference +13.06 mm, 95% CI, 10.05-16.07), and inferior left atrium (mean difference +11.19 mm, 95% CI, 7.84-14.53).

Conclusions: Hybrid arch repair with zones 0 to 5 leads to improved true lumen augmentation in zones 0 to 8 with complete false lumen thrombosis down to zone 5 at short-term follow-up. Zones 9 to 11, if involved, may require adjunctive treatment strategies for total aortic remodeling and complete false lumen obliteration.

Keywords: aneurysm; aortic arch; dissection; hybrid arch repair; thoracic endovascular repair.

Grants and funding

UL1 TR001863/TR/NCATS NIH HHS/United States