To characterize patient risk profiles and outcomes associated with staged ultra-hybrid
repair of extensive aortic disease, in which open thoracoabdominal completion was
performed after thoracic stent grafting. From 1/2006 to 1/2021, 92 patients underwent
open thoracoabdominal repair of chronic dissection (n=58, 63%), degenerative aneurysm
(n=28, 30%), endoleak (n=4, 4.3%), or symptomatic acute type B dissection (n=2, 2.2%)
after descending thoracic stent grafting (69, 75%), frozen elephant trunk (5, 5%),
or both (18, 20%). The surgical graft was sewn to the distal endovascular device in situ, reducing the extent of the open procedure and eliminating the need for hypothermic
circulatory arrest. Mean age was 58±13 years, 89 (97%) were hypertensive, 38 (43%)
had chronic obstructive pulmonary disease, 63 (72%) were smokers, 20 (24%) had a prior
stroke, and 33 (36%) had a suspected or confirmed heritable aortic condition. Hospital
mortality was 7.6% (n=7). Complications included dialysis (16, 20%), tracheostomy
(8, 8.7%), stroke (5, 5.7%), and permanent paralysis (6, 6.9%). Survival at 1, 3,
and 5 years was 80%, 71%, and 66%, respectively. Mortality was associated with higher
blood urea nitrogen and longer distance between the distal endograft edge and proximal
patent visceral vessel (P=0.004 and .01, respectively). Patients with extensive aortic disease undergoing open
aortic repair after thoracic stent grafting are often young with chronic dissection,
multiple comorbidities, or a heritable aortic condition. Success of staged ultra-hybrid
operations demonstrates open and endovascular repair strategies are complementary,
even when performed in a high-risk patient population.
Graphical Abstract
Graphical Abstract
Keywords
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Article info
Publication history
Published online: October 12, 2022
Publication stage
In Press Journal Pre-ProofFootnotes
Poster exhibited at the AATS 101st Annual Meeting: A Virtual Learning Experience, April 30 - May 2, 2021.
Material from this manuscript was presented as a poster at the 2021 American Association for Thoracic Surgery annual meeting.
This study was sponsored in part by the High Risk Cardiovascular Research Philanthropic Fund (Roselli).
Dr. Roselli discloses consulting relationships with Cook, CryoLife, Gore, Medtronic, and TerumoAortic.
IRB#: 4826, approved 03/24/2021 with waiver of informed consent.
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© 2022 Published by Elsevier Inc.
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- Commentary: A Tale of Two OperationsSeminars in Thoracic and Cardiovascular Surgery
- PreviewUltra-hybrid repair of thoracoabdominal aortic aneurysms (TAAAs) involves endovascular stenting of the descending thoracic aorta followed by distal open completion with a graft sutured to the distal end of the endograft.1 Hypothesized benefits include avoiding deep hypothermic circulatory arrest (DHCA) and decreasing spinal cord ischemia by allowing vascular collateralization between operations, as demonstrated in porcine models.2,3 Thompson et al. evaluate their single-center experience with ultra-hybrid repair among 92 patients undergoing open TAAA repair after prior stenting in the descending thoracic aorta with thoracic endovascular aneurysm repair (75%, n = 69), frozen elephant trunk (5.4%, n = 5), or both (20%, n = 18).
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