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| Mid-term Results of Hybrid Aortic Arch Repair Procedures |
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Kazuo Shimamura1, Toru Kuratani1, Yukitoshi Shirakawa1, Keiwa Kin1, Masaaki Kato2, Yoshiki Sawa1; 1Department of Cardiovascular Surgery, Osaka University Graduate School of Medecine, Osaka, Japan; 2Department of Cardiovascular Surgery, Morinomiya Hospital, Osaka, Japan Objective: Various kind of hybrid aortic arch repair is reported as a candidate of a good alternative to conventional aortic arch surgery, however there still is no consensus about the indication for these procedures. In this study, we evaluated the early and mid-term results of hybrid aortic arch repair procedures. Methods: 353 hybrid aortic arch repairs performed from January 1994 to August 2009 was retrospectively examined. Open stent grafting was the first line procedure, however, when adequate proximal landing could be achieved with cervical branch coverage, endovascular aortic repair (with cervical bypassing) was selected. Operative procedures included 126 simple open stent grafting, 135 branched open stent grafting, and 92 endovascular aortic repair with cervical branch coverage (bypass). The average age was 67.7 +/- 10.9 years, and the aortic pathology included 199 non-dissection aneurysms and 154 aortic dissections. Multivariable analysis with logistic regression analysis and Cox’s proportional hazard model was used to assess the risk factors. Results: Hospital mortality was 19/353(5.4%). Postoperative stroke (p=0.0054, OR 5.13) and preoperative renal failure (p=0.031, OR 3.50) was significant risk factor for hospital death. Postoperative complications included 24 strokes (6.7%), 13 spinal cord ischemia (SCI) (3.7%). There was no significant risk factor for stroke nor SCI, however incidence of SCI was significantly reduced in endovascular aortic repair (p=0.049). With average 36.2+/- 33.6 (1-153) months (1064 patents-year) follow up, overall survival was 86.2%, 70.8%, 62.3% at 1, 5 and 8 year respectively. Postoperative stroke (p=0.0004, OR 3.22), preoperative renal failure (p=0.031, OR 1.86), age (p=0.0013, OR 1.05) and early term operation (before 2000) (p=0.041, OR 1.75) were significant risk factors for late mortality. Freedom from aorta related death was 92.2%, 88.9%, and 85.4% at 1, 5 and 8 year respectively. Freedom from aortic event was 94.4%, 75.2% and 64.3% at 1, 5 and 8 years respectively, with male (p=0.042, OR 2.00) being significant risk factors of aortic event. Conclusion: Hybrid aortic arch repair procedures provided satisfactory early and mid-term results with good avoidance of aorta related death. Endovascular aortic repair with cervical branch coverage (bypassing) provided a satisfactory results even in high risk patients, which suggests the possibility of expanding the indication of this procedure. Back to 2010 Annual Meeting Back to Program Outline Back to Main Program |
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