Analysis of 5-year follow-up results of hybrid surgery for complex type B aortic dissection_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

TANG Feifei , CHENG Long , DAI Shilin , WANG Jie ,  SHANG Yuqiang

Department of Cardiovascular Surgery, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430014, P. R. China;

Corresponding author：

SHANG Yuqiang, Email: syq027@163.com

Keywords：

Stanford type B aortic dissection; hybrid surgery; left common carotid artery to left subclavian artery bypass; left subclavian artery transposition; thoracic endovascular aortic repair

DOI：

10.7507/1007-4848.202204072

Video：

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Objective To analyze the clinical effect of hybrid surgery on complex type B aortic dissection in 5 years. Methods A retrospective analysis of 47 patients with complex type B aortic dissection in the Central Hospital of Wuhan affiliated to Tongji Medical College of Huazhong University of Science and Technology from 2014 to 2017 was conducted, including 42 males and 5 females with an average age of 54.9±11.2 years. Twenty-one patients underwent the left common carotid artery to the left subclavian artery bypass (a bypass group), and 26 patients underwent the left common carotid artery to the left subclavian artery transposition (a transposition group). Results All patients accepted hybrid surgery successfully. There was no statistical difference in arterial occlusion time or intraoperative blood loss between the two groups (P＞0.05). The 5-year follow-up rate was 100.0% (47/47). During the follow-up period, 12 (25.5%) patients developed complications, including 5 (10.6%) patients of endoleak, 5 (10.6%) patients of hoarseness, 2 (4.3%) patients of stroke/dizziness. There was no patient of left upper limb weakness, paraplegia or retrograde aotic dissection. The reconstructed left subclavian artery remained patent in 46 (97.9%) patients. The overall 5-year survival rate was 100.0%. Conclusion The long-term therapeutic outcome of hybrid surgery for the treatment of complex type B aortic dissection is satisfying. In 5 years, the rebuilt left subclavian artery has a remarkable patency rate. Endoleak and hoarseness are the most common surgical complications.

Citation： TANG Feifei, CHENG Long, DAI Shilin, WANG Jie, SHANG Yuqiang. Analysis of 5-year follow-up results of hybrid surgery for complex type B aortic dissection. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2022, 29(10): 1342-1346. doi: 10.7507/1007-4848.202204072 Copy

1.	Pape LA, Awais M, Woznicki EM, et al. Presentation, diagnosis, and outcomes of acute aortic dissection: 17-year trends from the international registry of acute aortic dissection. J Am Coll Cardiol, 2015, 66(4): 350-358.
2.	Stelzmueller ME, Nolz R, Mahr S, et al. Thoracic endovascular repair for acute complicated type B aortic dissections. J Vasc Surg, 2019, 69(2): 318-326.
3.	Ehsan O, Murray D, Farquharson F, et al. Endovascular repair of complex aortic aneurysms. Ann Vasc Surg, 2011, 25(5): 716-725.
4.	Faure EM, Khantalin I, Peyron PA, et al. Experimental assessment of physician modified proximal scalloped stent graft to extend proximal landing zone in the aortic arch. Eur J Vasc Endovasc Surg, 2017, 54(2): 150-156.
5.	Patterson BO, Holt PJ, Nienaber C, et al. Management of the left subclavian artery and neurologic complications after thoracic endovascular aortic repair. J Vasc Surg, 2014, 60(6): 1491-1497.
6.	Zamor KC, Eskandari MK, Rodriguez HE, et al. Outcomes of thoracic endovascular aortic repair and subclavian revascularization techniques. J Am Coll Surg, 2015, 221(1): 93-100.
7.	Hiratzka LF, Bakris GL, Beckman JA, et al. 2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM guidelines for the diagnosis and management of patients with thoracic aortic disease. A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, American Association for Thoracic Surgery, American College of Radiology, American Stroke Association, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of Thoracic Surgeons, and Society for Vascular Medicine. J Am Coll Cardiol, 2010, 55(14): e27-e129.
8.	Lee WA. Failure modes of thoracic endografts: Prevention and management. J Vasc Surg, 2009, 49(3): 792-799.
9.	Crawford SA, Sanford RM, Forbes TL, et al. Clinical outcomes and material properties of in situ fenestration of endovascular stent grafts. J Vasc Surg, 2016, 64(1): 244-250.
10.	Mangialardi N, Ronchey S, Malaj A, et al. Value and limitations of chimney grafts to treat arch lesions. J Cardiovasc Surg (Torino), 2015, 56(4): 503-511.
11.	Bicknell CD, Cheshire NJ, Riga CV, et al. Treatment of complex aneurysmal disease with fenestrated and branched stent grafts. Eur J Vasc Endovasc Surg, 2009, 37(2): 175-181.
12.	Murphy EH, Beck AW, Clagett GP, et al. Combined aortic debranching and thoracic endovascular aneurysm repair (TEVAR) effective but at a cost. Arch Surg, 2009, 144(3): 222-227.
13.	Chen L, Qi RD, Liu W, et al. Repair of complicated chronic type B dissection with distal aortic arch involvement using left subclavian artery transposition with implantation of a stented elephant trunk. Thorac Cardiovasc Surg, 2017, 65(2): 99-104.
14.	Mandigers TJ, de Beaufort HWL, Smeenk HG, et al. Long-term patency of surgical left subclavian artery revascularization. J Vasc Surg, 2022, 75(6): 1977-1984.
15.	Zhou X, Lin M, Song M, et al. Early to mid-term results of thoracic endovascular aortic repair for type B aortic dissection. Chin J Vasc Surg, 2020, 5(3): 175-180.
16.	Wang T, Shu C, Li M, et al. Thoracic endovascular aortic repair with single/double chimney technique for aortic arch pathologies. J Endovasc Ther, 2017, 24(3): 383-393.
17.	Patel HJ, Williams DM, Drews JD, et al. A 20-year experience with thoracic endovascular aortic repair. Ann Surg, 2014, 260(4): 691-696.
18.	崔聪, 张力, 高夏, 等. 头臂血管转流并主动脉覆膜支架植入术在Stanford B1C型主动脉夹层中的应用. 中国胸心血管外科临床杂志, 2019, 26(2): 121-124.
19.	Lipsitz E, Michler RE, Neragi-Miandoab S. Hybrid arch debranching and proximal endograft extension to repair a type Ⅰ endoleak after endovascular thoracic aneurysm repair. Ann Vasc Surg, 2014, 28(3): 740.e7-12.
20.	Kerr N, Kerr J, Faed JM, et al. Spontaneous intracerebral haemorrhage: A rare complication of aortic aneurysm endoleak. BMJ Case Rep, 2018, 2018: bcr2018225249.
21.	Yoon JS, Suh JH, Kim DY, et al. Disseminated intravascular coagulopathy caused by type Ⅱ endoleak after endovascular aneurysm repair in severe aortic stenosis. J Thorac Dis, 2017, 9(11): E994-E996.
22.	Karube N, Uchida K, Cho T, et al. Coil embolization of intercostal arteries accessed by surgical exposure for type Ⅱ endoleak after thoracic endovascular aortic repair. J Vasc Surg, 2019, 70(1): 267-271.

1. Pape LA, Awais M, Woznicki EM, et al. Presentation, diagnosis, and outcomes of acute aortic dissection: 17-year trends from the international registry of acute aortic dissection. J Am Coll Cardiol, 2015, 66(4): 350-358.
2. Stelzmueller ME, Nolz R, Mahr S, et al. Thoracic endovascular repair for acute complicated type B aortic dissections. J Vasc Surg, 2019, 69(2): 318-326.
3. Ehsan O, Murray D, Farquharson F, et al. Endovascular repair of complex aortic aneurysms. Ann Vasc Surg, 2011, 25(5): 716-725.
4. Faure EM, Khantalin I, Peyron PA, et al. Experimental assessment of physician modified proximal scalloped stent graft to extend proximal landing zone in the aortic arch. Eur J Vasc Endovasc Surg, 2017, 54(2): 150-156.
5. Patterson BO, Holt PJ, Nienaber C, et al. Management of the left subclavian artery and neurologic complications after thoracic endovascular aortic repair. J Vasc Surg, 2014, 60(6): 1491-1497.
6. Zamor KC, Eskandari MK, Rodriguez HE, et al. Outcomes of thoracic endovascular aortic repair and subclavian revascularization techniques. J Am Coll Surg, 2015, 221(1): 93-100.
7. Hiratzka LF, Bakris GL, Beckman JA, et al. 2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM guidelines for the diagnosis and management of patients with thoracic aortic disease. A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, American Association for Thoracic Surgery, American College of Radiology, American Stroke Association, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of Thoracic Surgeons, and Society for Vascular Medicine. J Am Coll Cardiol, 2010, 55(14): e27-e129.
8. Lee WA. Failure modes of thoracic endografts: Prevention and management. J Vasc Surg, 2009, 49(3): 792-799.
9. Crawford SA, Sanford RM, Forbes TL, et al. Clinical outcomes and material properties of in situ fenestration of endovascular stent grafts. J Vasc Surg, 2016, 64(1): 244-250.
10. Mangialardi N, Ronchey S, Malaj A, et al. Value and limitations of chimney grafts to treat arch lesions. J Cardiovasc Surg (Torino), 2015, 56(4): 503-511.
11. Bicknell CD, Cheshire NJ, Riga CV, et al. Treatment of complex aneurysmal disease with fenestrated and branched stent grafts. Eur J Vasc Endovasc Surg, 2009, 37(2): 175-181.
12. Murphy EH, Beck AW, Clagett GP, et al. Combined aortic debranching and thoracic endovascular aneurysm repair (TEVAR) effective but at a cost. Arch Surg, 2009, 144(3): 222-227.
13. Chen L, Qi RD, Liu W, et al. Repair of complicated chronic type B dissection with distal aortic arch involvement using left subclavian artery transposition with implantation of a stented elephant trunk. Thorac Cardiovasc Surg, 2017, 65(2): 99-104.
14. Mandigers TJ, de Beaufort HWL, Smeenk HG, et al. Long-term patency of surgical left subclavian artery revascularization. J Vasc Surg, 2022, 75(6): 1977-1984.
15. Zhou X, Lin M, Song M, et al. Early to mid-term results of thoracic endovascular aortic repair for type B aortic dissection. Chin J Vasc Surg, 2020, 5(3): 175-180.
16. Wang T, Shu C, Li M, et al. Thoracic endovascular aortic repair with single/double chimney technique for aortic arch pathologies. J Endovasc Ther, 2017, 24(3): 383-393.
17. Patel HJ, Williams DM, Drews JD, et al. A 20-year experience with thoracic endovascular aortic repair. Ann Surg, 2014, 260(4): 691-696.
18. 崔聪, 张力, 高夏, 等. 头臂血管转流并主动脉覆膜支架植入术在Stanford B1C型主动脉夹层中的应用. 中国胸心血管外科临床杂志, 2019, 26(2): 121-124.
19. Lipsitz E, Michler RE, Neragi-Miandoab S. Hybrid arch debranching and proximal endograft extension to repair a type Ⅰ endoleak after endovascular thoracic aneurysm repair. Ann Vasc Surg, 2014, 28(3): 740.e7-12.
20. Kerr N, Kerr J, Faed JM, et al. Spontaneous intracerebral haemorrhage: A rare complication of aortic aneurysm endoleak. BMJ Case Rep, 2018, 2018: bcr2018225249.
21. Yoon JS, Suh JH, Kim DY, et al. Disseminated intravascular coagulopathy caused by type Ⅱ endoleak after endovascular aneurysm repair in severe aortic stenosis. J Thorac Dis, 2017, 9(11): E994-E996.
22. Karube N, Uchida K, Cho T, et al. Coil embolization of intercostal arteries accessed by surgical exposure for type Ⅱ endoleak after thoracic endovascular aortic repair. J Vasc Surg, 2019, 70(1): 267-271.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Analysis of 5-year follow-up results of hybrid surgery for complex type B aortic dissection

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