Hybrid Procedure without Sternotomy for Aortic Arch Dissection: A Shortand Mid-term Follow-up_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

ZHUShui-bo , ZHUJian ,  XIEr-ping , ZHANGYu , GAOXu-hui , WANGHai-bo , XUGui-hua , LiXue-mei

Department of Thoracic and Cardiovascular Surgery, Wuhan General Hospital of Guangzhou Command, Wuhan 430070, P. R. China;

Corresponding author：

XIEr-ping, Email: xierping@126.com

Keywords：

Aortic dissection; Endovascular repair; Aortic arch; Hybrid procedure

DOI：

10.7507/1007-4848.20160236

Video：

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Objective To evaluate the initial results of hybrid procedure without sternotomy for aortic arch dissection, and also report our initial experience in performing this procedure. Methods From January 2011 to September 2014, 17 patients diagnosed with aortic arch dissection by CT angiography undergoing the hybrid procedure (thoracic endovascular aortic repair combined with supra-arch branch vessel bypass) in the department of Thoracic Cardiovascular Surgery, Wuhan General Hospital of Guangzhou Command. There were 12 males and 5 females aged from 46 to 71 years. Their clinical data, including the imaging findings, treatment, and prognosis were retrospectively analyzed. Results Left common carotid artery (LCCA) to left subclavian artery (LSA) bypass (n=4), right common carotid artery (RCCA) to LCCA to LSA bypass (n=3), RCCA to LCCA bypass merger covered LSA (n=3) were performed. All operations were successful. Laryngeal recurrent nerve injury occurred in one patient. All patients were followed up on the postoperative day 7, 30 and one year. All patients were followed up for 12 to 53 months till September 2015. There was no death, and no complications such as endoleak after the hybrid procedure, stenosis or blockage of the bypass graft during the follow-up period. Conclusion Initial results suggest that the hybrid procedure without sternotomy is a suitable therapeutic option for high risk aortic arch dissection patients in poor general condition with little tolerance to aortic arch replacement．

Citation： ZHU Shui-bo, ZHU Jian, XI Er-ping, ZHANG Yu, GAO Xu-hui, WANG Hai-bo, XU Gui-hua, Li Xue-mei. Hybrid Procedure without Sternotomy for Aortic Arch Dissection: A Shortand Mid-term Follow-up. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2016, 23(10): 988-991. doi: 10.7507/1007-4848.20160236 Copy

1.	Ramanath VS, Oh JK, Sundt TM 3rd, et al. Acute aortic syndromes and thoracic aortic aneurysm. Mayo Clin Proc, 2009, 84(5): 465-481.
2.	郗二平,朱健,朱水波,等. 腔内修复术治疗急慢性DebakeyⅢ型夹层的临床研究. 中华全科医学, 2013, 11(5): 686-688.
3.	Ren C, Guo X, Sun L, et al. One-stage hybrid procedure without sternotomy for treating thoracic aortic pathologies that involve distal aortic arch: a single-center preliminary study. J Thorac Dis, 2015, 7(5): 861-867.
4.	Woo EY, Bavaria JE, Pochettino A, et al. Techniques for preserving vertebral artery perfusion during thoracic aortic stent grafting requiring aortic arch landing. Vasc Endovascular Surg, 2006, 40(5): 367-373.
5.	朱健, 郗二平, 朱水波. 腔内修复术治疗主动脉弓部动脉瘤的研究现状. 国际外科学杂志, 2012, 39(8): 559-562.
6.	Xi EP, Zhu J, Zhu SB, et al. Surgical treatment of aortoesophageal fistula induced by a foreign body in the esophagus: 40 years of experience at a single hospital. Surg Endosc, 2013, 27(9): 3412-3416.
7.	刘维永. 胸主动脉瘤及主动脉夹层外科治疗进展. 中国胸心血管外科临床杂志, 2003, 10 (1): 50-53.
8.	Zhang L, Lu Q, Zhou J, et al. Alternative management of the left subclavian artery in thoracic endovascular aortic repair for aortic dissection: a single-center experience. Eur J Med Res, 2015, 20: 57.
9.	Dexter D, Maldonado TS. Left subclavian artery coverage during TEVAR: is revascularization necessary? J Cardiovasc Surg (Torino), 2012, 53(2): 135-141.
10.	王冕,常光其,王深明,等. 升主动脉-颈动脉旁路联合腔内修复术治疗主动脉弓部病变. 中华外科医学, 2015, 53(2): 140-144.
11.	魏以桢, 常谦, 于存涛, 等. 一期杂交手术治疗累及主动脉弓远端的降主动脉病变. 中国胸心血管外科临床杂志, 2011, 18 (2): 99-103.
12.	丁盛, 张近宝, 欧阳辉, 等. 不同杂交方式治疗累及弓部的主动脉夹层. 中国胸心血管外科临床杂志, 2012, 19 (4): 435-437.
13.	Contrella BN, Sabri SS, Tracci MC, et al. Outcomes of coverage of the left subclavian artery during endovascular repair of the thoracic aorta. J Vasc Interv Radiol, 2015, 26(11): 1609-1614.
14.	Kihara K, Tamura K, Chikazawa G, et al. Hybrid three-stage repair for extended thoracoabdominal aortic aneurysm: report of a case. Ann Vasc Dis, 2015, 8(2): 106-109.
15.	Huang C, Tang H, Qiao T, et al. Early results of chimney technique for type B aortic dissections extending to the aortic arch. Cardiovasc Intervent Radiol, 2016, 39(1): 28-35.
16.	Thrumurthy SG, Karthikesalingam A, Patterson BO, et al. A systematic review of mid-term outcomes of thoracic endovascular repair (TEVAR) of chronic type B aortic dissection. Eur J Vasc Endovasc Surg, 2011, 42(5): 632-647.
17.	张瑜, 郗二平, 朱健, 等. 胸主动脉疾病腔内修复术中封闭左锁骨下动脉的可行性分析. 国际外科学杂志, 2012, 39(11): 760-762.
18.	Feng G, Qian Z, Jun G, et al. Hybrid repair of an aortic arch aneurysm using double parallel grafts perfused by retrograde flow in endovascular repair combined with left subclavian artery surgical bypass. Ann Thorac Surg, 2015, 100(5): 1888-1891.
19.	Kacila M, Vranic H, Straus S. Extensive operation as one of the solution for patients with the insufficient proximal landing zone for TEVAR in aortic dissection short term results. Acta Inform Med, 2014, 22(6): 356-359.
20.	Ockert S, Eckstein G, Lutz B, et al. Aortic hemiarch hybrid repair. J Vasc Surg, 2015, 62(4): 907-913.

1. Ramanath VS, Oh JK, Sundt TM 3rd, et al. Acute aortic syndromes and thoracic aortic aneurysm. Mayo Clin Proc, 2009, 84(5): 465-481.
2. 郗二平,朱健,朱水波,等. 腔内修复术治疗急慢性DebakeyⅢ型夹层的临床研究. 中华全科医学, 2013, 11(5): 686-688.
3. Ren C, Guo X, Sun L, et al. One-stage hybrid procedure without sternotomy for treating thoracic aortic pathologies that involve distal aortic arch: a single-center preliminary study. J Thorac Dis, 2015, 7(5): 861-867.
4. Woo EY, Bavaria JE, Pochettino A, et al. Techniques for preserving vertebral artery perfusion during thoracic aortic stent grafting requiring aortic arch landing. Vasc Endovascular Surg, 2006, 40(5): 367-373.
5. 朱健, 郗二平, 朱水波. 腔内修复术治疗主动脉弓部动脉瘤的研究现状. 国际外科学杂志, 2012, 39(8): 559-562.
6. Xi EP, Zhu J, Zhu SB, et al. Surgical treatment of aortoesophageal fistula induced by a foreign body in the esophagus: 40 years of experience at a single hospital. Surg Endosc, 2013, 27(9): 3412-3416.
7. 刘维永. 胸主动脉瘤及主动脉夹层外科治疗进展. 中国胸心血管外科临床杂志, 2003, 10 (1): 50-53.
8. Zhang L, Lu Q, Zhou J, et al. Alternative management of the left subclavian artery in thoracic endovascular aortic repair for aortic dissection: a single-center experience. Eur J Med Res, 2015, 20: 57.
9. Dexter D, Maldonado TS. Left subclavian artery coverage during TEVAR: is revascularization necessary? J Cardiovasc Surg (Torino), 2012, 53(2): 135-141.
10. 王冕,常光其,王深明,等. 升主动脉-颈动脉旁路联合腔内修复术治疗主动脉弓部病变. 中华外科医学, 2015, 53(2): 140-144.
11. 魏以桢, 常谦, 于存涛, 等. 一期杂交手术治疗累及主动脉弓远端的降主动脉病变. 中国胸心血管外科临床杂志, 2011, 18 (2): 99-103.
12. 丁盛, 张近宝, 欧阳辉, 等. 不同杂交方式治疗累及弓部的主动脉夹层. 中国胸心血管外科临床杂志, 2012, 19 (4): 435-437.
13. Contrella BN, Sabri SS, Tracci MC, et al. Outcomes of coverage of the left subclavian artery during endovascular repair of the thoracic aorta. J Vasc Interv Radiol, 2015, 26(11): 1609-1614.
14. Kihara K, Tamura K, Chikazawa G, et al. Hybrid three-stage repair for extended thoracoabdominal aortic aneurysm: report of a case. Ann Vasc Dis, 2015, 8(2): 106-109.
15. Huang C, Tang H, Qiao T, et al. Early results of chimney technique for type B aortic dissections extending to the aortic arch. Cardiovasc Intervent Radiol, 2016, 39(1): 28-35.
16. Thrumurthy SG, Karthikesalingam A, Patterson BO, et al. A systematic review of mid-term outcomes of thoracic endovascular repair (TEVAR) of chronic type B aortic dissection. Eur J Vasc Endovasc Surg, 2011, 42(5): 632-647.
17. 张瑜, 郗二平, 朱健, 等. 胸主动脉疾病腔内修复术中封闭左锁骨下动脉的可行性分析. 国际外科学杂志, 2012, 39(11): 760-762.
18. Feng G, Qian Z, Jun G, et al. Hybrid repair of an aortic arch aneurysm using double parallel grafts perfused by retrograde flow in endovascular repair combined with left subclavian artery surgical bypass. Ann Thorac Surg, 2015, 100(5): 1888-1891.
19. Kacila M, Vranic H, Straus S. Extensive operation as one of the solution for patients with the insufficient proximal landing zone for TEVAR in aortic dissection short term results. Acta Inform Med, 2014, 22(6): 356-359.
20. Ockert S, Eckstein G, Lutz B, et al. Aortic hemiarch hybrid repair. J Vasc Surg, 2015, 62(4): 907-913.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Hybrid Procedure without Sternotomy for Aortic Arch Dissection: A Shortand Mid-term Follow-up

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