Abstract 17462: Mid-Term Results of Hybrid Aortic Arch Repair Procedures for Aortic Dissections
Background: Hybrid aortic arch repair for aortic dissection had emerged as an alternative to open surgery, however its late results is still not well described. We evaluated the mid-term results of this procedure in our 16 years experience.(Patients and Method) Among 353 hybrid aortic arch repairs performed during 1994 and 2009, 154 hybrid aortic arch repairs for aortic dissection (119 open stent grafting (OSG) and 35 thoracic endovascular aortic repair (TEVAR) covering arch vessels) were enrolled in this study. The first line procedure was OSG, however TEVAR was mainly selected for high risk patients when anatomically indicated. The patient average age was 62.8years old. The status of aortic dissection was type A/ type B = 72/82, acute/chronic=53/101, including 25 (16.6%) of previous ascending aortic replacement cases. The distal diameter of stent graft was oversized by 5–10% of the true lumen.
Results: Operative mortality within 30 days was 4/154(2.6%). In average follow up of 51.6±43.3 months (maximum 187 months), the overall freedom from dissection related death was 91.5%, 89.1% at 5, 8 year respectively. As stent graft related event, 3 distal endoleak and 15 ulcer formation at the distal end of the stent graft was observed, however all these events were successfully treated by additional TEVAR. By multivariate analysis, risk factors for late graft related event was chronic dissection (p=.029) and larger stent graft distal diameter (P=.001). In sub-analysis, TEVAR provided excellent avoidance of dissection related death (figure) and satisfactory freedom rate from graft related event (83.1%/5year, 83.1%/8year in TEVAR and 73.6%/5year, 68.4%/8year in OSG, p=n.s).
Conclusion: Hybrid aortic arch repair for aortic dissection provided satisfactory results even in late phase. Although the indication was restricted by anatomical factor, TEVAR provided excellent results even in late phase, which suggested the possibility of expanding its indication.
- © 2010 by American Heart Association, Inc.