Evaluation of the Hybrid Treatment of the Aortic Arch for Dissecting aneUrYsm

Abstract

Objectives: This study evaluates the results of a hybrid procedure associating transposition of the supra aortic trunks and endovascular treatment for dissecting aneurysms involving the aortic arch. Materials and Methods: We studied the clinical, CT and surgical data of all the patients who had a hybrid treatment of the aortic arch for a dissecting aneurysm in our service. Results: Between March 2005 and April 2015, 32 patients had a hybrid treatment of the aortic arch for dissecting aneurysm. Mean age was 64.3 +/- 12.4 years. The average diameter of the aneurysm was 60.2 +/- 15.1 mm. The patients were treated for an aneurysm >55 mm in 27 cases, an increase of the aortic diameter >1 cm/year in three cases, and ruptured aneurysm in two cases. Ten patients had a revascularization of all the supra aortic trunks in zones 0, of which two had a concomitant replacement of the ascending aorta. A partial transposition of the supra aortic trunks was carried out in 22 patients of which eight in zone 1 and 14 in zone 2. At 30 days, technical success was 97%. There was no intra-hospital death. One patient died at D20 of cirrhotic decompensation. Thirty days death rate was then 3%. The rate of cerebral vascular complications was 6% (n=2). One patient had a postoperative paraplegia (3%) with complete recovery after drainage of the cerebrospinal liquid. One patient had a retrograde dissection four days after a hybrid treatment in zone 1. He had a replacement of the ascending aorta with reimplantation of the coronary arteries in emergency with uneventful postoperative course. The rates of cardiac, pulmonary and renal complications were 3%, 7%, and 7% respectively. After 30 days, with an average follow-up of 20 months (20 days-10 years), the total death rate was 12% (n=4) with three late deaths. Eight patients developed an endoleak, and two of them required a reintervention. Overall, eight reinterventions were carried out (25%), within an average of 8.7 months (1.2-24.6 months). Conclusion: The hybrid treatment of the aortic arch for a dissecting aneurysm is associated with a low death rate, including in patients treated in zone 0. However, due to the high rates of endoleaks and reintervention in the mid and long term, a regular and long term follow-up of these patients is recommended.