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CC BY 4.0 · Aorta (Stamford) 2021; 09(01): 021-029
DOI: 10.1055/s-0041-1724003
Original Research Article

National Outcomes of Elective Hybrid Arch Debranching with Endograft Exclusion versus Total Arch Replacement Procedures: Analysis of the Society of Thoracic Surgeons Adult Cardiac Surgery Database

Tyler Wallen 
1   Division of Cardiovascular Surgery, The University of Florida, Gainesville, Florida
,
Timothy Carter
2   Division of Cardiovascular Surgery, The University of Pennsylvania Health System, Philadelphia, Pennsylvania
,
Andreas Habertheuer
1   Division of Cardiovascular Surgery, The University of Florida, Gainesville, Florida
,
Vinay Badhwar
3   Division of Cardiac Surgery, West Virginia University Heart and Vascular Institute, Morgantown, West Virginia
,
Jeffrey P. Jacobs
1   Division of Cardiovascular Surgery, The University of Florida, Gainesville, Florida
,
Babatunde Yerokun 
4   Duke University Medical Center, Durham, North Carolina
,
Amelia Wallace
4   Duke University Medical Center, Durham, North Carolina
,
Karianna Milewski
1   Division of Cardiovascular Surgery, The University of Florida, Gainesville, Florida
,
Wilson Y. Szeto
1   Division of Cardiovascular Surgery, The University of Florida, Gainesville, Florida
,
Joseph E. Bavaria
1   Division of Cardiovascular Surgery, The University of Florida, Gainesville, Florida
,
Prashanth Vallabhajosyula
5   Division of Cardiothoracic Surgery, Yale University School of Medicine, New Haven, Connecticut
› Institutsangaben
Funding None.
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Abstract

Objective Hybrid arch procedures (arch vessel debranching with thoracic endovascular aneurysm repair [TEVAR] coverage of arch pathology) have been presented as an alternative to total arch replacement (TAR). But multicenter-based analyses of these two procedures are needed to benchmark the field and establish areas of improvement.

Methods The Society of Thoracic Surgeons (STS) Adult Cardiac Surgery Database from July 2014 to December 2015 was queried for elective TAR and hybrid arch procedures. Demographics and operative characteristics were compared and stepwise variable selection was used to create a risk-set used for adjustment of all multivariable models.

Results A total of 1,011 patients met inclusion criteria, 884 underwent TAR, and 127 had hybrid arch procedures. TAR patients were younger (mean age: 62.7 ± 13.3 vs. 66.7 ± 11.9 years; p = 0.001) and had less peripheral vascular disease (34.0 vs. 49.6%; p < 0.001) and preoperative dialysis (1.7 vs. 4.7%; p = 0.026), but similar history of stroke (p = 0.91)/cerebrovascular disease (p = 0.52). TAR patients had more concomitant procedures (60 vs. 34.6%; p < 0.0001). TAR patients had lower mortality (6.7 vs. 12.6%; p = 0.02), stroke (6.9 vs. 15%; p = 0.002), paralysis (1.8 vs. 7.1%; p = 0.002), renal failure (4.6 vs. 8.7%; p = 0.045), and STS morbidity (34.2 vs. 42.5%; p = 0.067). Composite mortality, stroke, and paralysis were significantly lower with TAR (11.5 vs. 25.2%; p = 0.0001). After risk adjustment, analysis showed hybrid arch procedures imparted an increased odds of mortality (odds ratio [OR] = 1.91, p = 0.046), stroke (OR = 2.3, p = 0.005), and composite endpoint of stroke or mortality (OR = 2.31, p = 0.0002).

Conclusion TAR remains the gold standard for elective aortic arch pathologies. Despite risk adjustment, hybrid arch procedures were associated with increased risk of mortality and stroke, advocating for careful adoption of these strategies.

Keywords

thoracic - aorta - hybrid - aneurysm


Publikationsverlauf

Eingereicht: 22. Juli 2019

Angenommen: 02. Oktober 2020

Artikel online veröffentlicht:
04. Oktober 2021

© 2021. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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  • References

  • 1 Bavaria J, Vallabhajosyula P, Moeller P, Szeto W, Desai N, Pochettino A. Hybrid approaches in the treatment of aortic arch aneurysms: postoperative and midterm outcomes. J Thorac Cardiovasc Surg 2013; 145 (3, suppl): S85-S90
    CrossrefPubMedSuche in Google Scholar
  • 2 Benedetto U, Melina G, Angeloni E, Codispoti M, Sinatra R. Current results of open total arch replacement versus hybrid thoracic endovascular aortic repair for aortic arch aneurysm: a meta-analysis of comparative studies. J Thorac Cardiovasc Surg 2013; 145 (01) 305-306
    CrossrefPubMedSuche in Google Scholar
  • 3 Leontyev S, Misfeld M, Daviewala P. et al. Early- and medium-term results after aortic arch replacement with frozen elephant trunk techniques-a single center study. Ann Cardiothorac Surg 2013; 2 (05) 606-611
    PubMedSuche in Google Scholar
  • 4 Shrestha M, Pichlmaier M, Martens A, Hagl C, Khaladj N, Haverich A. Total aortic arch replacement with a novel four-branched frozen elephant trunk graft: first-in-man results. Eur J Cardiothorac Surg 2013; 43 (02) 406-410
    CrossrefPubMedSuche in Google Scholar
  • 5 Vallabhajosyula P, Szeto W, Desai N, Bavaria JE. Type I and Type II hybrid aortic arch replacement: postoperative and mid-term outcome analysis. Ann Cardiothorac Surg 2013; 2 (03) 280-287
    PubMedSuche in Google Scholar
  • 6 Settepani F, Cappai A, Basciu A, Barbone A, Tarelli G. Outcome of open total arch replacement in the modern era. J Vasc Surg 2016; 63 (02) 537-545
    CrossrefPubMedSuche in Google Scholar
  • 7 Williams JB, Peterson ED, Zhao Y. et al. Contemporary results for proximal aortic replacement in North America. J Am Coll Cardiol 2012; 60 (13) 1156-1162
    CrossrefPubMedSuche in Google Scholar
  • 8 Zanotti G, Reece TB, Aftab M. Aortic arch pathology: Surgical options for the aortic arch replacement. Cardiol Clin 2017; 35 (03) 367-385
    CrossrefPubMedSuche in Google Scholar
  • 9 Iafrancesco M, Ranasinghe AM, Dronavalli V. et al. Open aortic arch replacement in high-risk patients: the gold standard. Eur J Cardiothorac Surg 2016; 49 (02) 646-651 , discussion 651
    CrossrefPubMedSuche in Google Scholar
  • 10 Iba Y, Minatoya K, Matsuda H. et al. How should aortic arch aneurysms be treated in the endovascular aortic repair era? A risk-adjusted comparison between open and hybrid arch repair using propensity score-matching analysis. Eur J Cardiothorac Surg 2014; 46 (01) 32-39
    CrossrefPubMedSuche in Google Scholar
  • 11 Roselli EE, Rafael A, Soltesz EG, Canale L, Lytle BW. Simplified frozen elephant trunk repair for acute DeBakey type I dissection. J Thorac Cardiovasc Surg 2013; 145 (3, suppl): S197-S201
    CrossrefPubMedSuche in Google Scholar
  • 12 Tokuda Y, Oshima H, Narita Y. et al. Hybrid versus open repair of aortic arch aneurysms: comparison of postoperative and mid-term outcomes with a propensity score-matching analysis. Eur J Cardiothorac Surg 2016; 49 (01) 149-156
    CrossrefPubMedSuche in Google Scholar
  • 13 Vallabhajosyula P, Gottret JP, Robb JD. et al. Hemiarch replacement with concomitant antegrade stent grafting of the descending thoracic aorta versus total arch replacement for treatment of acute DeBakey I aortic dissection with arch tear. Eur J Cardiothorac Surg 2016; 49 (04) 1256-1261 , discussion 1261
    CrossrefPubMedSuche in Google Scholar
  • 14 Moulakakis KG, Mylonas SN, Markatis F, Kotsis T, Kakisis J, Liapis CD. A systematic review and meta-analysis of hybrid aortic arch replacement. Ann Cardiothorac Surg 2013; 2 (03) 247-260
    CrossrefPubMedSuche in Google Scholar
  • 15 Berretta P, Di Eusanio M. Descending endograft for DeBakey type 1 aortic dissection: pro. Ann Cardiothorac Surg 2016; 5 (03) 222-226
    CrossrefPubMedSuche in Google Scholar
  • 16 Hsu HL, Chen YY, Huang CY, Huang JH, Chen JS. The provisional extension to induce complete attachment (PETTICOAT) technique to promote distal aortic remodelling in repair of acute DeBakey type I aortic dissection: preliminary results. Eur J Cardiothorac Surg 2016; 50 (01) 146-152
    CrossrefPubMedSuche in Google Scholar
  • 17 Sultan I, Wallen TJ, Habertheuer A. et al. Concomitant antegrade stent grafting of the descending thoracic aorta during transverse hemiarch reconstruction for acute DeBakey I aortic dissection repair improves aortic remodeling. J Card Surg 2017; 32 (09) 581-592
    CrossrefPubMedSuche in Google Scholar
  • 18 Hofferberth SC, Newcomb AE, Yii MY. et al. Hybrid proximal surgery plus adjunctive retrograde endovascular repair in acute DeBakey type I dissection: superior outcomes to conventional surgical repair. J Thorac Cardiovasc Surg 2013; 145 (02) 349-354 , discussion 354–355
    CrossrefPubMedSuche in Google Scholar
  • 19 Shrestha M, Haverich A, Martens A. Total aortic arch replacement with the frozen elephant trunk procedure in acute DeBakey type I aortic dissections. Eur J Cardiothorac Surg 2017; 51 (Suppl. 01) i29-i34
    CrossrefPubMedSuche in Google Scholar
  • 20 Shrestha M, Kaufeld T, Beckmann E. et al. Total aortic arch replacement with a novel 4-branched frozen elephant trunk prosthesis: single-center results of the first 100 patients. J Thorac Cardiovasc Surg 2016; 152 (01) 148-159.e1
    CrossrefPubMedSuche in Google Scholar
  • 21 Vallabhajosyula P, Szeto WY, Pulsipher A. et al. Antegrade thoracic stent grafting during repair of acute Debakey type I dissection promotes distal aortic remodeling and reduces late open distal reoperation rate. J Thorac Cardiovasc Surg 2014; 147 (03) 942-948
    CrossrefPubMedSuche in Google Scholar