OBJECTIVES: Recent advances in endovascular aortic repair have changed the treatment of aortic arch aneurysms. The purpose of this study was to compare the early and mid-term outcomes of open repair and hybrid arch repair for aortic arch aneurysms. METHODS: This study included 143 and 50 patients who underwent open aortic repair and hybrid thoracic endovascular aortic repair (TEVAR), respectively, for non-dissecting aortic arch aneurysms from 2008 to 2013. The European System for Cardiac Operative Risk Evaluation II scores were 4.35 ± 3.65% and 7.78 ± 5.49% for the open and hybrid TEVAR groups, respectively (P < 0.001). Furthermore, 35 patients from each group were matched using propensity scores to adjust for differences in patient characteristics. RESULTS: There was no significant difference in early mortality between the open and hybrid groups (3 vs 2%, P = 0.76). Early morbidity was equivalent in both groups, but intensive care unit (ICU) lengths of stay were shorter in members of the hybrid group (4.7 vs 1.6 days, P = 0.018). During the follow-up, survival rates were not significantly different (87 vs 81% at 3 years, P = 0.13), but reinterventions for the aortic arch were required in 1 patient (pseudoaneurysm) in the open group and 5 (endoleak in 4, brachiocephalic artery stenosis in 1) in the hybrid group. The rates of freedom from reintervention at 3 years were 99% in the open group and 80% in the hybrid group (P < 0.001). Propensity score matching yielded similar results for shorter ICU and hospital lengths of stay and more frequent reintervention in the hybrid group. CONCLUSIONS: Surgical outcomes in both groups were satisfactory. Hybrid TEVAR was superior in terms of early recovery from surgery; however, open arch repair showed more reliable long-term outcomes. When properly selected according to patient risk, these two strategies improve the surgical results in all patients with aortic arch aneurysms.
OBJECTIVES: Recent advances in endovascular aortic repair have changed the treatment of aortic arch aneurysms. The purpose of this study was to compare the early and mid-term outcomes of open repair and hybrid arch repair for aortic arch aneurysms. METHODS: This study included 143 and 50 patients who underwent open aortic repair and hybrid thoracic endovascular aortic repair (TEVAR), respectively, for non-dissecting aortic arch aneurysms from 2008 to 2013. The European System for Cardiac Operative Risk Evaluation II scores were 4.35 ± 3.65% and 7.78 ± 5.49% for the open and hybrid TEVAR groups, respectively (P < 0.001). Furthermore, 35 patients from each group were matched using propensity scores to adjust for differences in patient characteristics. RESULTS: There was no significant difference in early mortality between the open and hybrid groups (3 vs 2%, P = 0.76). Early morbidity was equivalent in both groups, but intensive care unit (ICU) lengths of stay were shorter in members of the hybrid group (4.7 vs 1.6 days, P = 0.018). During the follow-up, survival rates were not significantly different (87 vs 81% at 3 years, P = 0.13), but reinterventions for the aortic arch were required in 1 patient (pseudoaneurysm) in the open group and 5 (endoleak in 4, brachiocephalic artery stenosis in 1) in the hybrid group. The rates of freedom from reintervention at 3 years were 99% in the open group and 80% in the hybrid group (P < 0.001). Propensity score matching yielded similar results for shorter ICU and hospital lengths of stay and more frequent reintervention in the hybrid group. CONCLUSIONS: Surgical outcomes in both groups were satisfactory. Hybrid TEVAR was superior in terms of early recovery from surgery; however, open arch repair showed more reliable long-term outcomes. When properly selected according to patient risk, these two strategies improve the surgical results in all patients with aortic arch aneurysms.
Authors: Ehsan Benrashid; Hanghang Wang; Jeffrey E Keenan; Nicholas D Andersen; James M Meza; Richard L McCann; G Chad Hughes Journal: J Vasc Surg Date: 2015-10-27 Impact factor: 4.268
Authors: Steve Xydas; Christos G Mihos; Roy F Williams; Angelo LaPietra; Maurice Mawad; S Howard Wittels; Orlando Santana Journal: J Thorac Dis Date: 2017-06 Impact factor: 2.895
Authors: Orhan Gökalp; Levent Yılık; Hasan İner; Yüksel Beşir; Nihan Karakaş Yeşilkaya; Kazım Ergüneş; Banu Lafcı; Ali Gürbüz Journal: Turk Gogus Kalp Damar Cerrahisi Derg Date: 2018-07-03 Impact factor: 0.332