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

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-anat...

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Detalles Bibliográficos
Autores principales: Chen, Su-Wei, Zhong, Yong-Liang, Qiao, Zhi-Yu, Li, Cheng-Nan, Ge, Yi-Peng, Qi, Rui-Dong, Hu, Hai-Ou, Sun, Li-Zhong, Zhu, Jun-Ming
Formato: Online Artículo Texto
Lenguaje:English
Publicado: AME Publishing Company 2020
Materias:
Original Article
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7797852/
https://www.ncbi.nlm.nih.gov/pubmed/33447400
http://dx.doi.org/10.21037/jtd-20-2338
Descripción
Sumario: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.

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