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

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

JOURNAL=Frontiers in Cardiovascular Medicine

VOLUME=9

YEAR=2022

URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2022.882783

DOI=10.3389/fcvm.2022.882783

ISSN=2297-055X

ABSTRACT=<sec><title>Background</title><p>The 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.</p></sec><sec><title>Methods</title><p>200 patients with various diffuse aortic pathologies involving the arch were enrolled between 2016 and 2019. Complex arch diseases included acute type A dissection (<italic>n</italic> = 129, 64.5%), acute type B dissection (<italic>n</italic> = 16, 8.0%), aortic arch aneurysm (<italic>n</italic> = 42, 21.0%) and penetrating arch ulcer (<italic>n</italic> = 13, 6.5%). Mortality, morbidity, survival and re-intervention were analyzed.</p></sec><sec><title>Results</title><p>The 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 (<italic>n</italic> = 1), anastomotic leak at the site of the proximal ascending aorta (<italic>n</italic> = 1) and the type I endoleak (<italic>n</italic> = 1).</p></sec><sec><title>Conclusions</title><p>Type II HAR was performed with satisfactory early and mid-term outcomes in complex aortic arch pathologies.</p></sec>