Arch debranching versus elephant trunk procedures for hybrid repair of thoracic aortic pathologies.

BACKGROUND: We compared outcomes of arch debranching (AD) and elephant trunk (ET) techniques when used with thoracic endovascular aortic repair.
METHODS: A review was performed of consecutive patients with proximal thoracic aortic pathologies repaired with a hybrid approach.
RESULTS: Between 2005 and 2009, 58 patients underwent first-stage ET (n = 21) or AD (n = 37). Cardiopulmonary bypass was utilized in 100% of ET procedures and 68% of AD procedures (p < 0.01). Circulatory arrest was used in 86% of ET and 27% of AD cases (p < 0.01). The second stage was completed in 76% of ET and 76% of AD patients. Rates of spinal cord ischemia (ET 0 of 21, AD 0 of 37, p = 1.0), stroke (ET 2 of 21, AD 4 of 37, p = 1.0), and 30-day mortality (ET 4 of 21, AD 6 of 37, p = 1.0) were similar. Each group had one major aortic complication between the two stages. Type Ia endovascular leak at 1 and 12 months occurred in 13% ET patients and 4% AD patients at 1 month (p = 0.54) and in 0% ET patients and 4% AD patients at 12 months (p = 1.0). Kaplan-Meier estimates of survival at 1 and 12 months were 90.5% ± 6.4% and 73.1% ± 10% in the ET group, and 86.5% ± 5.6 and 71.6% ± 8.5 in the AD group, respectively (p = 0.68). The risk of a secondary procedure at 1 and 12 months was 76.2% ± 9.3% and 58.7% ± 12% in the ET group, and 71.0% ± 7.8% and 52.8% ± 10% in the AD group, respectively (p = 0.86).
CONCLUSIONS: Arch debranching achieves equivalent results to standard elephant trunk repair but with a decreased need for cardiopulmonary bypass and circulatory arrest. Copyright Â