ObjectiveTo report our clinical experience and outcomes of thoracic endovascular aortic repair (TEVAR) for acute Stanford type A dissection using ascending aorta replacement combined with implantation of a fenestrated stent-graft of the entire aortic arch through a minimally invasive technique. MethodsFrom 2016 to 2020 in our hospital, 24 patients (17 males and 7 females, aged 45-72 years) with complicated Stanford type A aortic dissection, underwent replacement of the proximal ascending aorta with TEVAR. None of the patients with dissection involved the three branches of the superior arch, and all patients were replaced with artificial blood vessels of the ascending aorta under non-hypothermic cardiopulmonary bypass, preserving the arch and the three branches above the arch, and individualized stent graft fenestration. ResultsSurgical technical success rate was 100.0%. There was no intraoperative complication or evidence of endo-leak in 1 month postoperatively. Hospital stay was 10±5 d. During postoperative follow-up, the stent was unobstructed without displacement, the preserved branch of the aortic arch was unobstructed, and the true lumen of the descending aorta was enlarged. Conclusion This hybrid technique by using TEVAR with fenestrated treatment is a minimally invasive and effective method to treat high-risk patients with acute Stanford type A aortic dissection.
Surgical intervention for chronic thoracoabdominal aortic dissecting aneurysms (cTAADA) is regarded as one of the most challenging procedures in the field of vascular surgery. For nearly six decades, open repair predominantly utilizing prosthetic grafts has been the treatment of choice for cTAADA. With advances in minimally invasive endovascular technologies, two novel surgical approaches have emerged: total endovascular stent-graft repair and hybrid procedures combining retrograde debranching of visceral arteries with endovascular stent-graft repair (abbreviated as hybrid procedure). Although total endovascular stent-graft repair offers reduced trauma and quicker recovery, limitations persist in clinical application due to hostile anatomical requirements of the aorta, high costs, and the lack of universally available stent-graft products. Hybrid repair, integrating the minimally invasive ethos of endovascular repair with visceral artery debranching techniques, has increasingly become a significant surgical modality for managing thoracoabdominal aneurysms, especially in cases unsuitable for open surgery or total endovascular treatment due to anatomical constraints such as aortic tortuosity or narrow true lumens in dissections. Recent enhancements in hybrid surgical approaches include ongoing optimization of visceral artery reconstruction strategies based on hemodynamic analyses, and exploration of the comparative benefits of staged versus concurrent surgical interventions.
Objective To discusses the feasibilities of the hybrid surgical treatment of Stanford type B aortic dissection. Methods From August 2011 to August 2015 a total of 14 cases of complex Stanford type B aortic dissection patients had been completed hybrid surgery. Among them 11 cases of men and 3 cases of women, aged 22 to 62, an average of 44±7.2 years old. Twelve cases with dissecting aneurysm involving the aortic arch and its three vascular branch. There were 2 cases of patients after TEVER, occurred new dissection or pseudoaneurysms, and had hybrid surgery by traditional thoracotomy; 3 cases involving carotid artery were received neck-neck hybrid surgery, and 7 cases involving left subclavian artery were received neck-lock hybrid surgery. Two cases of dissecting aneurysm involving the iliac artery to thrombosis that result in lower limb ischemia, then femoral to femoral artery hybrid surgery were performed. Results All the patients were successfully completed the operation of covered stent implantation and hybrid surgery. Intraoperative angiography showed that the position of the stent was accurate, the interlayer isolation was successful, there was no obvious leakage and displacement of the stent, the true lumen blood flow of the aortic dissection was returned to normal, and bypass blood and target blood vessels were unobstructed. Fourteen patients were followed-up for a period of 3 to 36 months, with an average of (24.0±8.2) months. In 1 month after operation, pleural effusion occurred in 1 case, there was 1 case of cerebral stroke in two days after surgery, incision hematoma occurred in 1 case in 10 days after surgery, and the other patients had no postoperative death and severe complications. All 14 patients were followed-up and returned to normal life. Conclusion The hybrid operations can increase the success rate of TEVAR in complex Stanford type B aortic dissection patients, and early and mid-term results are satisfactory.
ObjectiveTo review current research on aortic arch management strategies in type A aortic dissection (TAAD) and provide a reference for surgical decision-making. MethodsA comprehensive literature search was conducted on aortic arch management techniques globally. ResultsCurrent research shows three managment for type A aortic dissection surgical startegies:open surgery remains the gold standard but is associated with elevated perioperative mortality and significant postoperative complication rates;endovascular repair,while demonstrating reduced complication incidence, presents substantial technical challenges that hinder widespread clinical adoption;Hybrid procedures exhibit lower acute complication rates, yet long-term outcomes remain uncertain. ConclusionsAs one of the most lethal emergencies of cardiovascular surgery , TAAD requires immediate intervention. While open surgery is the current gold standard, it presents clinical challenges including elevated mortality and morbidity. Future research must focus on reducing operative duration without compromising success rates.
Objective To evaluate the importance of "one-stop" hybrid operating room in the individualized treatment of aortic pathology. Method We retrospectively analyzed the clinical data of 247 patients of aortic pathology who were operated in the hybrid operating room in our hospital from January 2013 through December 2014. There were 193 males and 54 females at age of 24-83(54±12) years. Results Thoracic or abdominal endovascular aortic repair (TEVAR/EVAR) was applied in 132 patients, including 122 simple patients and 10 complexes. Fenestrated TEVAR was applied in 61 patients. Hybrid operation was done in 54 patients. Perioperative death occurred in 9 patients (3.6%). Perioperative complication rate was 11.7% (29/247) . The patients were followed up for one year. During follow-up, five patients were dead. The one-year survival rate was 98.0% (242/247) . Conclusions "One-stop" individualized treatment of aortic pathology shows its advantage, yet long-term result still needs to be followed up.
ObjectiveTo investigate the feasibility and safety of hybrid coronary revascularization (HCR) in patients with multivessel coronary artery disease (MVCAD).MethodsA total of 50 patients with MVCAD who underwent HCR technique in our heart center from May 2016 to April 2019 were included in this study (a HCR group), including 38 patients who underwent two-stage HCR and 12 patients one-stop HCR. There were 39 males and 11 females, with an average age of 62.4 (46-82) years. Another 482 patients who underwent conventional median incision under off-pump coronary artery bypass grafting (OPCAB) at the same period were selected as control (an OPCAB group), including 392 males and 90 females, with an average age of 64.2 (48-84) years. The safety and feasibility of HCR were evaluated and compared with conventional OPCAB technique.ResultsThere was no perioperative death in both groups. Compared with the OPCAB, HCR was associated with shorter operation time, less chest tube drainage, lower requirement of blood transfusion, shorter mechanical ventilation time and shorter postoperative intensive care unit (ICU) stay (P<0.05). There was no statistical difference in the incidence of major adverse cardiac or cerebrovascular events during the follow-up of 6 to 36 months between the two groups.ConclusionHCR provides favorable short and mid-term outcomes for selected patients with MVCAD compared with conventional OPCAB.