Midterm results and experience with the hybrid approach for complex thoracic aortic disease

Objective: In aortic disease hybrid techniques are discussed controversially. We report our results and experience of developing the method (phase 1) and implantation of an integrated stentgraft hybrid prosthesis (phase 2), for one stage repair in complex aortic disease.

Patients and methods: Between 06/2001 and 08/2006, 34 patients (24 men (71%); age 61±11) with complex aortic disease were treated (phase 1 n=14 pts, phase 2 n=20 pts). During phase 1 conventional stentgrafts were used. 22 (65%) patients were operated on for type A AD (16 acute, 6 chronic), 7 (20%) for complicated type B AD combined with retrograde extension to ascending aorta (4/7) or aneurysm (3/7) and 5 (15%) for aneurismal disease. In phase 2 (01/2005) the new developed hybrid stentgraft with an integrated vascular Dacron prosthesis for continuous arch replacement was used (20/34, 59%).

Results: In 13 patients of phase one and in all patients of phase 2 the hybrid approach was feasible. A secondary intervention was necessary in 2 pts of phase 1, but in none of phase 2. Overall hospital mortality was 15% (5/34; 3 pts phase 1, 2 pts phase 2). Late mortality was 17% (5/29; 2 pts phase 1, 3 pts phase 2).

Conclusion: Phase 1 demonstrated the technical feasibility, but revealed the shortcomings of conventional devices. The new hybrid stentgraft (phase 2) fulfills the requirements of open surgical implantation and allows for continuous arch replacement.