Debranching Solutions in Endografting for Complex Thoracic Aortic Dissections

Background

Conventional surgical repair of thoracic aortic dissections is a challenge due tomortality and morbidity risks.

Objectives

We analyzed our experience in hybrid aortic arch repair for complex dissections ofthe aortic arch.

Methods

Between 2009 and 2013, 18 patients (the mean age of 67 ± 8 years-old)underwent hybrid aortic arch repair. The procedural strategy was determined on theindividual patient.

Results

Thirteen patients had type I repair using trifurcation and another patient withbifurcation graft. Two patients had type II repair with replacement of theascending aorta. Two patients received extra-anatomic bypass grafting to leftcarotid artery allowing covering of zone 1. Stent graft deployment rate was 100%.No patients experienced stroke. One patient with total debranching of the aorticarch following an acute dissection of the proximal arch expired 3 months afterTEVAR due to heart failure. There were no early to midterm endoleaks. The medianfollow-up was 20 ± 8 months with patency rate of 100%.

Conclusion

Various debranching solutions for different complex scenarios of the aortic archserve as less invasive procedures than conventional open surgery enabling safe andeffective treatment of this highly selected subgroup of patients with complexaortic pathologies.