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Long-term outcomes for hybrid aortic arch repair.

Publication ,  Journal Article
Vekstein, AM; Jensen, CW; Weissler, EH; Downey, PS; Kang, L; Gaca, JG; Long, CA; Hughes, GC
Published in: J Vasc Surg
November 25, 2023

OBJECTIVE: Since its inception in the early 2000s, hybrid arch repair (HAR) has evolved from novel approach to well-established treatment modality for aortic arch pathology in appropriately selected patients. Despite this nearly 20-year history of use, long-term results of HAR remain to be determined. As such, objectives of this study are to detail the long-term outcomes for HAR within an expanded classification scheme. METHODS: From August 2005 to August 2022, 163 consecutive patients underwent HAR at a single referral institution. Operative approach was selected according to an institutional algorithm and included zone 0/1 HAR in 25% (n = 40), type I HAR in 34% (n = 56), and type II/III HAR in 41% (n = 67). Specific zone 0/1 technique was zone 1 HAR in 31 (78%), zone 0 with innominate snorkel (zone 0S HAR) in 7 (18%), and zone 0 with single side-branch endograft (zone 0B HAR) in 2 (5%). The 30-day and long-term outcomes, including overall and aortic-specific survival, as well as freedom from reintervention, were assessed. RESULTS: The mean age was 63 ± 13 years and almost one-half of patients (47% [n = 77]) had prior sternotomy. Presenting pathology included degenerative aneurysm in 44% (n = 71), residual dissection after prior type A repair in 38% (n = 62), chronic type B dissection in 12% (n = 20), and other indications in 6% (n = 10). Operative outcomes included 9% mortality (n = 14) at 30 days, 5% mortality (n = 8) in hospital, 4% stroke (n = 7), 2% new dialysis (n = 3), and 2% permanent paraparesis/plegia (n = 3). The median follow-up was 44 month (interquartile range, 12-84 months). Overall survival was 59% and 47% at 5 and 10 years, respectively, whereas aorta-specific survival was 86% and 84% at the same time points. At 5 and 10 years, freedom from major reintervention was 92% and 91%, respectively. Institutional experience had a significant impact on both early and late outcomes: comparing the first (2005-2012) and second (2013-2022) halves of the series, 30-day mortality decreased from 14% to 1% (P = .01) and stroke from 6% to 3% (P = .62). Improved operative outcomes were accompanied by improved late survival, with 78% of patients in the later era vs 45% in the earlier era surviving to 5 years. CONCLUSIONS: HAR is associated with excellent operative outcomes, as well as sustained protection from adverse aortic events as evidenced by high long-term aorta-specific survival and freedom from reintervention. However, surgeon and institutional experience appear to play a major role in achieving these superior outcomes, with a five-fold decrease in operative mortality and a two-fold decrease in stroke rate in the latter half of the series. These long-term results expand on prior midterm data and continue to support use of HAR for properly selected patients with arch disease.

Duke Scholars

Published In

J Vasc Surg

DOI

EISSN

1097-6809

Publication Date

November 25, 2023

Location

United States

Related Subject Headings

  • Cardiovascular System & Hematology
  • 3202 Clinical sciences
  • 3201 Cardiovascular medicine and haematology
  • 11 Medical and Health Sciences
 

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Vekstein, A. M., Jensen, C. W., Weissler, E. H., Downey, P. S., Kang, L., Gaca, J. G., … Hughes, G. C. (2023). Long-term outcomes for hybrid aortic arch repair. J Vasc Surg. https://doi.org/10.1016/j.jvs.2023.11.032
Vekstein, Andrew M., Christopher W. Jensen, E Hope Weissler, Peter S. Downey, Lillian Kang, Jeffrey G. Gaca, Chandler A. Long, and G Chad Hughes. “Long-term outcomes for hybrid aortic arch repair.J Vasc Surg, November 25, 2023. https://doi.org/10.1016/j.jvs.2023.11.032.
Vekstein AM, Jensen CW, Weissler EH, Downey PS, Kang L, Gaca JG, et al. Long-term outcomes for hybrid aortic arch repair. J Vasc Surg. 2023 Nov 25;
Vekstein, Andrew M., et al. “Long-term outcomes for hybrid aortic arch repair.J Vasc Surg, Nov. 2023. Pubmed, doi:10.1016/j.jvs.2023.11.032.
Vekstein AM, Jensen CW, Weissler EH, Downey PS, Kang L, Gaca JG, Long CA, Hughes GC. Long-term outcomes for hybrid aortic arch repair. J Vasc Surg. 2023 Nov 25;
Journal cover image

Published In

J Vasc Surg

DOI

EISSN

1097-6809

Publication Date

November 25, 2023

Location

United States

Related Subject Headings

  • Cardiovascular System & Hematology
  • 3202 Clinical sciences
  • 3201 Cardiovascular medicine and haematology
  • 11 Medical and Health Sciences