Frontiers in Cardiovascular Medicine (Jun 2022)

Early and Midterm Outcomes of Type II Hybrid Arch Repair for Complex Aortic Arch Pathology

  • Yanxiang Liu,
  • Bowen Zhang,
  • Shenghua Liang,
  • Yaojun Dun,
  • Hongwei Guo,
  • Xiangyang Qian,
  • Cuntao Yu,
  • Xiaogang Sun

DOI
https://doi.org/10.3389/fcvm.2022.882783
Journal volume & issue
Vol. 9

Abstract

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BackgroundThe hybrid arch repair (HAR) is an appealing surgical option in the management of aortic arch diseases. The aim is to evaluate the short and mid-term outcomes of type II HAR involving replacement of the ascending aorta, arch debranching, and zone 0 stent graft deployment in diverse arch pathologies.Methods200 patients with various diffuse aortic pathologies involving the arch were enrolled between 2016 and 2019. Complex arch diseases included acute type A dissection (n = 129, 64.5%), acute type B dissection (n = 16, 8.0%), aortic arch aneurysm (n = 42, 21.0%) and penetrating arch ulcer (n = 13, 6.5%). Mortality, morbidity, survival and re-intervention were analyzed.ResultsThe overall 30-day mortality rate was 8.0% (16/200). Stroke was present in 3.5% (7/200) of the general cohort and spinal cord injury was occurred in 3.0% (6/200). Multivariable logistic analysis showed that cardiac malperfusion and CPB time were the risk factors associated with 30-day mortality. The mean follow-up duration was 25.9 months (range 1–57.2 months), and the 3-year survival rate was 83.1%. On Cox regression analysis, age, diabetes, cardiac malperfusion and CPB time predicted short and mid-term overall mortality. A total of 3 patients required reintervention during the follow-up due to the thrombosis of epiaortic artificial vessels (n = 1), anastomotic leak at the site of the proximal ascending aorta (n = 1) and the type I endoleak (n = 1).ConclusionsType II HAR was performed with satisfactory early and mid-term outcomes in complex aortic arch pathologies.

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