Single Stage Hybrid Repair for DeBakey Type I Aortic Dissection in High Risk Patients

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Abstract

Objectives: To evaluate the efficacy of the less invasive hybrid zone 0 (Z0) total aortic arch repair (HAR, ascending repair + complete debranching + thoracic endovascular aortic repair [TEVAR]) without deep hypothermic circulatory arrest in management of DeBakey type I aortic dissection (IAD). The adverse outcome was defined as a single composite endpoint comprising peri-operative mortality, permanent neurological deficit, and renal failure necessitating haemodialysis at discharge. Methods: A retrospective review of prospectively collected data was conducted of 120 consecutive patients (mean EuroSCORE = 11.6%) with IAD undergoing HAR (urgent/emergency, n = 97, 80.8%) involving reconstruction of the ascending aorta (zone 0) and total arch exclusion with TEVAR during a 7.5 year period. Multivariable analysis of 27 potential pre-operative and intra-operative risk factors was performed to examine the early composite endpoint and short and long-term overall mortality. Results: The total early (30 day or in hospital) mortality was 9.2% (n = 11). The incidence of the composite endpoint was 11.7% (n = 14). On multivariable analysis, malperfusion syndromes were predictors of the composite endpoint (odds ratio [OR], 4.789; 95% CI 1.362–16.896; p =.015), and previous cerebrovascular accident (OR, 13.74; 95% CI 2.330–81.039; p =.004) and myocardial ischaemia time (OR, 1.038; 95% CI 1.015–1.061; p =.001) predicted short and long-term overall mortality. The overall survival was 84.7% during a median follow up of 3.4 years. Freedom from late aortic adverse events was 93.1% at 5 years, including secondary aortic intervention and endoleak. The maximum diameters of the true lumen increased significantly in stented thoracic (14.4 ± 6.5 mm to 29.7 ± 5.3 mm, p <.001), lower thoracic (14.2 ± 6 mm to 21.6 ± 7.2 mm, p <.001) and abdominal (11.7 ± 4.8 mm to 17.4 ± 4.1 mm, p <.001) aorta. Complete thrombosis of the peri-stent false lumen was achieved in 88.2% of CT scans (82/93) performed a mean of 12 ± 17 months (median 5 months; 25–75% quartile, 2–12 months) post-operatively. Conclusions: IAD was treated safely and durably by Z0 HAR, and peri-operative mortality and morbidity were not substantially higher despite the older age and high risk of patients.

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Lin, H., Du, Y., Yu, C., Qian, X., Sun, X., Tian, C., … Chang, Q. (2018). Single Stage Hybrid Repair for DeBakey Type I Aortic Dissection in High Risk Patients. European Journal of Vascular and Endovascular Surgery, 56(3), 363–372. https://doi.org/10.1016/j.ejvs.2018.05.023

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