Hybrid Approach in Patients with Aortic and Supra-aortic Pathologies: Early Outcomes

Background: Fourty eight patients with complex supra-aortic disease, underwent hybrid supra-aortic debranching and endovascular stenting. Thirty-day major adverse cardiac and cerebrovascular events were recorded and analyzed.

Methods and material: In this single center study hybrid procedures were conducted over a 10 year period. Patients were categorized into 2 groups of 24 each; aortic aneurysms and aortic dissections. The procedures were classified as elective, urgent and emergent and performed in the hybrid operating room. Median sternotomy was performed by the cardiac surgeon and moderate hypothermic (23–28°C) circulatory arrest established after cardiopulmonary bypass was initiated. Supra-aortic debranching and endovascular stenting was performed by the vascular surgeon. Cerebral perfusion was maintained at 18°C via the brachiocephalic truncus, axillary or carotid arteries, with a flow rate of 10–20ml/kg/min and a mean arterial pressure at 70mmHg. Mean hypothermic circulatory arrest time was 28 minute.

Results: Operative freedom from endoleaks was 92%, while 30-day freedom from death and cerebrovascular events was 84% and 82% respectively.

Conclusion: Patients with aortic aneurysms or dissections extending into the arch and/or supra-aortic vessels can be treated successfully using a hybrid approach. Major adverse cardiac and cerebrovascular events are at least comparable to conventional lone procedures hitherto performed in this group of patients.