10. Hybrid aortic surgery our early experience

Abstract

We report our early experience of hybrid aortic arch and descending thoracic aortic surgery with/without concomitant cardiac procedures. Between December 2010 and October 2012, 7 patients underwent hybrid aortic surgery with 4 patients requiring concomitant cardiac procedures (AVR-1, CABG-2 and ascending aortic replacement + CABG-1). There were 6 males :1 female patient. The operations were performed electively in 5 patients, and as an emergency in 2 patients. All patients underwent relocation of innominate and right carotid arteries to the proximal ascending aorta using a 4 side armed Dacron graft, either as a patch or a tube graft. The left subclavian artery was closed in all cases either surgically or percutaneously with an amplatz vascular occlusion device. Following relocation of the head and neck vessels, the aortic arch and descending thoracic aorta were stented with either a Medtronic Thoracic Valiant Aortic Stent (4 cases) or the Jotec Open E Vita Stent (3 cases). The procedures were carried out as a one stage operation in 6 cases and as a 2 stage operation in 1 case. Morbidities include acute renal failure (1 patient) and left hemiplegia (1 patient). None developed paraplegia. 1 patient died 2 weeks postoperatively from perforated duodenal ulcers. This technique enables endovascular stenting of the aortic arch and descending thoracic aneurysms with concomitant cardiac procedures. The relocation of the carotid arteries prior to endovascular stenting of the arch may protect against cerebral embolisation from atheroma dislodged during antegrade deployment of the endovascular stent. This technique also allows antegrade cerebral and coronary perfusion during circulatory arrest. Hybrid aortic surgery is a feasible alternative treatment for patients with extensive aortic arch and descending thoracic aneurysms with concomitant cardiac pathologies.