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A 10-Year Aortic Center Experience with Hybrid Repair of Chronic “Residual” Aortic Dissection After Type A Repair

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Abstract

Purpose

Hybrid aortic arch repair in patients with chronic residual aortic dissection (RAD) is a less invasive alternative to conventional surgical treatment. The aim of this study was to describe the short-term and long-term results of hybrid treatment for RAD after type A repair.

Methods

In this retrospective single-center cohort study, all patients treated for chronic RAD with hybrid aortic arch repair were included. Indications for treatment were rapid aortic growth, aortic diameter > 55 mm, or aortic rupture.

Results

Between 2009 and 2020, we performed 29 hybrid treatments for chronic RAD. Twenty-four patients were treated for complete supra-aortic debranching in zones 0 and 5 with left subclavian artery debranching alone in zone 2. There was 1 perioperative death (3.4%): The patient was treated for an aortic rupture. There was no spinal cord ischemia and 1 minor stroke (3.4%). After a median follow-up of 25.4 months (range 3-97 months), the long-term mortality was 10.3% (3/29) with no late aortic-related deaths. Twenty-seven patients (93.1%) developed FL thrombosis of the descending thoracic aorta; the rate of aneurysmal progression on thoraco-abdominal aorta was 41.4% (12/29), and the rate of aortic reintervention was 34.5% (10/29).

Conclusion

In a high-volume aortic center, hybrid repair of RAD is associated with good anatomical results and a low risk of perioperative morbidity and mortality, including that of patients treated in zone 0. A redo replacement of the ascending aortic segment is sometimes necessary to provide a safer proximal landing zone and reduce the risk of type 1 endoleak after TEVAR.

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Availability of Data and Material

All the patients included in this study were clearly informed about the use of their data for clinical research, and the institutional review board approved the project (approval number 2019-48).

Code Availability

Not applicable.

Abbreviations

RAD:

Residual aortic dissection after type A repair

HR:

Hybrid repair

TEVAR:

Thoracic endovascular aortic repair

SA:

Supra-aortic

IA:

Innominate artery

LCCA:

Left common carotid artery

LSA:

Left subclavian artery

CPB:

Cardiopulmonary bypass

CA:

Circulatory arrest

ACP:

Antegrade cerebral protection

CT:

Computed tomography

CSFD:

Cerebrospinal fluid drainage

STABILISE:

Stent-assisted balloon-induced intimal disruption and relamination in aortic dissection repair

FL:

False lumen

NIRS:

Near-infrared spectroscopy

SCI:

Spinal cord ischemia

CI:

Confidence interval

FET:

Frozen elephant trunk

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Acknowledgements

We would like to thank Professor Michel S. Makaroun (Pittsburgh, PA) for his careful reading and comments.

Author information

Authors and Affiliations

  1. Department of Vascular Surgery, Timone Hospital, APHM, 13005, Marseille, France

    Marine Gaudry, Arnaud Blanchard, Jean-Victor Chazot, Laurence Bal, Mariangela De Masi & Philippe Piquet

  2. Timone Aortic Center, Timone Hospital, APHM, 13005, Marseille, France

    Marine Gaudry, Alizée Porto, Arnaud Blanchard, Jean-Victor Chazot, Laurence Bal, Mariangela De Masi, Axel Bartoli, Pierre-Antoine Barral, Alexis Jacquier, Vlad Gariboldi, Fréderic Collart & Philippe Piquet

  3. Department of Cardiac Surgery, Timone Hospital, APHM, 13005, Marseille, France

    Alizée Porto, Vlad Gariboldi & Fréderic Collart

  4. Department of Radiology, Timone Hospital, APHM, 13005, Marseille, France

    Axel Bartoli, Pierre-Antoine Barral & Alexis Jacquier

  5. Aix-Marseille Université, CNRS, Ecole Centrale Marseille, IRPHE UMR 7342, 13384, Marseille, France

    Valérie Deplano

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  1. Marine Gaudry
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Alizée Porto, Arnaud Blanchard, Jean Victor Chazot, Laurence Bal, Mariangela De Masi, Pierre-Antoine Barral, Alexis Jacquier, Vlad Gariboldi, Frederic Collart, Valerie Deplano, and Marine Gaudry. The first draft of the manuscript was written by Marine Gaudry, Philippe Piquet, and Alizee Porto. Axel Bartoli made all figure revisions needed to improve the manuscript. All authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Marine Gaudry.

Ethics declarations

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all participants included in the study.

Conflict of Interest

The authors declare no competing interests.

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Meeting presentation: European Society of Vascular Surgery (ESVS), Hamburg, September 2019

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Gaudry, M., Porto, A., Blanchard, A. et al. A 10-Year Aortic Center Experience with Hybrid Repair of Chronic “Residual” Aortic Dissection After Type A Repair. Cardiovasc Drugs Ther 36, 285–294 (2022). https://doi.org/10.1007/s10557-021-07150-w

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