"Hybrid" Repair of Aneurysms of the Transverse Aortic Arch: Midterm Results

G. Chad Hughes, Mani A. Daneshmand, Keki R. Balsara, Hardean A. Achneck, Bantayehu Sileshi, Sean M. Lee, Richard L. McCann

Research output: Contribution to journalArticle

54 Scopus citations

Abstract

Background: Aneurysms of the transverse aortic arch, especially those involving the mid to distal arch, are technically challenging to repair with conventional open techniques. We present our results with a combined open/endovascular approach ("hybrid repair") in such patients. Methods: From August 11, 2005, to September 18, 2008, 28 patients underwent hybrid arch repair. For patients (n = 9) with distal arch aneurysms but 2 cm or more of proximal landing zone (PLZ) distal to the innominate artery, right to left carotid-carotid bypass was performed to create a PLZ by covering the left carotid origin. For patients (n = 12) with mid arch aneurysms but 2 cm or more of PLZ in the ascending aorta, proximal ascending aorta-based arch debranching was performed. For patients (n = 7) with arch aneurysms with no adequate PLZ ("mega aorta") but adequate distal landing zone, a stage 1 elephant trunk procedure was performed to create a PLZ. For the first two groups, endovascular aneurysm exclusion and debranching were performed concomitantly, whereas the procedures were staged for the group undergoing an initial elephant trunk procedure. Results: Mean patient age was 64 ± 13 years. Primary technical success rate was 100%. Thirty-day/in-hospital rates of death, stroke, and permanent paraplegia/paresis were 0%, 0%, and 3.6% (n = 1), respectively. At a mean follow-up of 14 ± 11 months, there have been no late aortic-related events. Two patients (7%) required secondary endovascular reintervention for a type 1 endovascular leak. No patient has a type 1 or 3 endovascular leak at latest follow-up. Conclusions: Hybrid repair of transverse aortic arch aneurysms appears safe and effective at midterm follow-up and may represent a technical advance in the treatment of this pathology.

Original languageEnglish (US)
Pages (from-to)1882-1888
Number of pages7
JournalAnnals of Thoracic Surgery
Volume88
Issue number6
DOIs
StatePublished - Dec 1 2009

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

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    Hughes, G. C., Daneshmand, M. A., Balsara, K. R., Achneck, H. A., Sileshi, B., Lee, S. M., & McCann, R. L. (2009). "Hybrid" Repair of Aneurysms of the Transverse Aortic Arch: Midterm Results. Annals of Thoracic Surgery, 88(6), 1882-1888. https://doi.org/10.1016/j.athoracsur.2009.07.027