OBJECTIVES: Operative strategies for repairing aortic arch aneurysms should be re-evaluated following recent technical advances. METHODS: Of 364 patients who underwent aortic arch repair between 2002 and 2014, 58 were high-risk subjects who received isolated hybrid arch repair (HAR) via median sternotomy (type I n = 32, type II n = 1 and type III n = 25). During this period, excluding patients with type A dissection or extensive aneurysms, 124 patients received isolated open arch repair via median sternotomy. The patients in the HAR and open arch repair groups were compared. A propensity score-matching analysis was applied to adjust for baseline risk factors. RESULTS: The patients in the HAR group were older (77 years ± 6 vs 69 ± 9, P < 0.0001), exhibited a greater rate of malignancy (21 vs 4.8%, P = 0.0022) and had higher logistic EuroSCORE values (31 ± 18 vs 20 ± 15, P < 0.0001) than those in the open arch repair group. Following propensity score matching creating 38 matched pairs, the differences in preoperative risk diminished. Operative complications, including the mortality rate (2.6 vs 0%), were similar between the groups. Apart from the lower rates of cardiopulmonary bypass (CPB) and circulatory arrest, there was no apparent superiority of HAR with respect to patient recovery. The mean follow-up duration was 52.5 months, during which the rate of freedom from aortic events in the HAR and open arch repair groups was 79 and 99% at 24 months, respectively (P < 0.0001). CONCLUSIONS: HAR achieves equivalent short-term results to standard open arch repair, with a decreased need for CPB. However, considering the inferior mid-term outcomes of this procedure, its indications should be limited to high-risk patients.
OBJECTIVES: Operative strategies for repairing aortic arch aneurysms should be re-evaluated following recent technical advances. METHODS: Of 364 patients who underwent aortic arch repair between 2002 and 2014, 58 were high-risk subjects who received isolated hybrid arch repair (HAR) via median sternotomy (type I n = 32, type II n = 1 and type III n = 25). During this period, excluding patients with type A dissection or extensive aneurysms, 124 patients received isolated open arch repair via median sternotomy. The patients in the HAR and open arch repair groups were compared. A propensity score-matching analysis was applied to adjust for baseline risk factors. RESULTS: The patients in the HAR group were older (77 years ± 6 vs 69 ± 9, P < 0.0001), exhibited a greater rate of malignancy (21 vs 4.8%, P = 0.0022) and had higher logistic EuroSCORE values (31 ± 18 vs 20 ± 15, P < 0.0001) than those in the open arch repair group. Following propensity score matching creating 38 matched pairs, the differences in preoperative risk diminished. Operative complications, including the mortality rate (2.6 vs 0%), were similar between the groups. Apart from the lower rates of cardiopulmonary bypass (CPB) and circulatory arrest, there was no apparent superiority of HAR with respect to patient recovery. The mean follow-up duration was 52.5 months, during which the rate of freedom from aortic events in the HAR and open arch repair groups was 79 and 99% at 24 months, respectively (P < 0.0001). CONCLUSIONS: HAR achieves equivalent short-term results to standard open arch repair, with a decreased need for CPB. However, considering the inferior mid-term outcomes of this procedure, its indications should be limited to high-risk patients.
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