Zhang Kefeng1, Pan Xudong, Liu Yongmin, Zhu Junming, Huang Lianjun, Zhang Jian, Sun Lizhong. 1. Department of Cardiovascular Surgery, Xuanwu Hospital, Capital Medical University, Xicheng District, Beijing, China; Beijing Aortic Disease Center, Beijing Anzhen Hospital, Capital Medical University, Chaoyang District, Beijing, China.
Abstract
OBJECTIVES: To retrospectively summarize clinical experiences and mid-term follow-up outcomes of hybrid operation for Type B aortic dissection involving the distal arch. METHODS: From February 2009 to April 2013, 15 consecutive patients (6 males and 9 females) with Type B aortic dissection (acute, n = 10; chronic, n = 5) involving the distal aortic arch underwent a hybrid operation. RESULTS: The patients' median age was 62 (68-44) years. The median hospital stay was 14 (19-11) days. The hybrid procedure was performed in 15 patients comprising seven in zone 1 and eight in zone 2. Technical success was achieved in 100% and no case of paraplegia was reported. Thirty-day mortality and stroke were 0%. At a median follow-up of 12 months (range, 4-52 months), a stroke and death occurred in one patient not associated with an endograft complication. At follow-up, the overall mortality was 6.7% (1 of 15). A computed tomography scan was performed in 13 of 15 patients and thrombus formation was observed in the descending aortic false lumen excluded by the stented graft in most patients. The overall late endoleak rate was 7.7% (1 of 13); retrograde dissection occurred in no patient. There are no differences between acute and chronic aortic dissection or proximal landing zone 1 and landing zone 2 except for proximal endograft dimension. CONCLUSIONS: Hybrid operation for Type B aortic dissection involving the distal aortic arch appears safe and effective at mid-term follow-up and may extend the application of endovascular repair in the treatment of this pathology.
OBJECTIVES: To retrospectively summarize clinical experiences and mid-term follow-up outcomes of hybrid operation for Type B aortic dissection involving the distal arch. METHODS: From February 2009 to April 2013, 15 consecutive patients (6 males and 9 females) with Type B aortic dissection (acute, n = 10; chronic, n = 5) involving the distal aortic arch underwent a hybrid operation. RESULTS: The patients' median age was 62 (68-44) years. The median hospital stay was 14 (19-11) days. The hybrid procedure was performed in 15 patients comprising seven in zone 1 and eight in zone 2. Technical success was achieved in 100% and no case of paraplegia was reported. Thirty-day mortality and stroke were 0%. At a median follow-up of 12 months (range, 4-52 months), a stroke and death occurred in one patient not associated with an endograft complication. At follow-up, the overall mortality was 6.7% (1 of 15). A computed tomography scan was performed in 13 of 15 patients and thrombus formation was observed in the descending aortic false lumen excluded by the stented graft in most patients. The overall late endoleak rate was 7.7% (1 of 13); retrograde dissection occurred in no patient. There are no differences between acute and chronic aortic dissection or proximal landing zone 1 and landing zone 2 except for proximal endograft dimension. CONCLUSIONS: Hybrid operation for Type B aortic dissection involving the distal aortic arch appears safe and effective at mid-term follow-up and may extend the application of endovascular repair in the treatment of this pathology.