Nikolaos A Papakonstantinou1, Constantine N Antonopoulos2, Nikolaos G Baikoussis3, Ioannis Kakisis4, Georgios Geroulakos4. 1. Cardiovascular and Thoracic Surgery Department, General Hospital of Athens "Evangelismos", Athens, Greece. Electronic address: nikppk@yahoo.gr. 2. Cardiovascular and Thoracic Surgery Department, General Hospital of Athens "Evangelismos", Athens, Greece. 3. 1st Cardiac Surgery Department, General Hospital of Athens Hippocratio, Athens, Greece. 4. Vascular Surgery Department, "Attikon" Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece.
Abstract
INTRODUCTION: Conventional open total arch replacement is the treatment of choice for surgical aortic arch pathologies. However, it is an invasive procedure, requiring cardiopulmonary bypass and deep hypothermic circulatory arrest leading to significant morbidity and mortality rates. Hybrid aortic arch debranching procedures without (type I) or with (type II) ascending aorta replacement seek to limit operative, bypass, and circulatory arrest times by making the arch repair procedure simpler and shorter. MATERIAL AND METHODS: A meta-analysis and detailed review of the literature published from January 2013 until December 2016, concerning hybrid aortic arch debranching procedures was conducted and data for morbidity and mortality rates were extracted. RESULTS: As far as type I hybrid aortic arch reconstruction is concerned, among the 122 patients included, the pooled endoleak rate was 10.78% (95%CI=1.94-23.40), 30-day or in-hospital mortality was 3.89% (95%CI=0.324-9.78), stroke rate was 3.79% (95%CI=0.25-9.77) and weighted permanent paraplegia rate was 2.4%. In terms of type II hybrid approach, among 40 patients, endoleak rate was 12.5%, 30-day or in-hospital mortality rate was 5.3%, stroke rate was 2.5%, no permanent paraplegia was noticed and late mortality rate was 12.5%. CONCLUSIONS: Hybrid aortic arch debranching procedures are a safe alternative to open repair with acceptable short- and mid-term results. They extend the envelope of intervention in aortic arch pathologies, particularly in high-risk patients who are suboptimal candidates for open surgery.
INTRODUCTION: Conventional open total arch replacement is the treatment of choice for surgical aortic arch pathologies. However, it is an invasive procedure, requiring cardiopulmonary bypass and deep hypothermic circulatory arrest leading to significant morbidity and mortality rates. Hybrid aortic arch debranching procedures without (type I) or with (type II) ascending aorta replacement seek to limit operative, bypass, and circulatory arrest times by making the arch repair procedure simpler and shorter. MATERIAL AND METHODS: A meta-analysis and detailed review of the literature published from January 2013 until December 2016, concerning hybrid aortic arch debranching procedures was conducted and data for morbidity and mortality rates were extracted. RESULTS: As far as type I hybrid aortic arch reconstruction is concerned, among the 122 patients included, the pooled endoleak rate was 10.78% (95%CI=1.94-23.40), 30-day or in-hospital mortality was 3.89% (95%CI=0.324-9.78), stroke rate was 3.79% (95%CI=0.25-9.77) and weighted permanent paraplegia rate was 2.4%. In terms of type II hybrid approach, among 40 patients, endoleak rate was 12.5%, 30-day or in-hospital mortality rate was 5.3%, stroke rate was 2.5%, no permanent paraplegia was noticed and late mortality rate was 12.5%. CONCLUSIONS: Hybrid aortic arch debranching procedures are a safe alternative to open repair with acceptable short- and mid-term results. They extend the envelope of intervention in aortic arch pathologies, particularly in high-risk patients who are suboptimal candidates for open surgery.
Authors: Nikolaos C Schizas; Aikaterini P Dedeilia; Ilias Samiotis; Theodoros Kratimenos; Nikolaos G Baikoussis; Panagiotis G Dedeilias Journal: Indian J Thorac Cardiovasc Surg Date: 2021-03-19
Authors: Piotr Buczkowski; Mateusz Puslecki; Sebastian Stefaniak; Robert Juszkat; Jerzy Kulesza; Marcin Misterski; Tomasz Urbanowicz; Marcin Ligowski; Bartosz Zabicki; Marek Dabrowski; Lukasz Szarpak; Damian Gorczyca; Marek Jemielity; Bartłomiej Perek Journal: J Thorac Dis Date: 2019-06 Impact factor: 2.895