Neurologic Outcomes in Aortic Arch Repair With Frozen Elephant Trunk Versus 2-Stage Hybrid Repair
We compared outcomes of single-stage hybrid aortic arch replacement (frozen elephant trunk) versus 2-stage hybrid repairs with primary open arch procedures followed by thoracic endovascular stenting. This study reports a single-center retrospective review (2003 to 2016) of 118 patients undergoing hy...
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| Published in: | The Annals of thoracic surgery Vol. 107; no. 6; pp. 1775 - 1781 |
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| Main Authors: | , , , , , , , |
| Format: | Journal Article |
| Language: | English |
| Published: |
Netherlands
Elsevier Inc
01-06-2019
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| Subjects: | |
| Online Access: | Get full text |
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| Summary: | We compared outcomes of single-stage hybrid aortic arch replacement (frozen elephant trunk) versus 2-stage hybrid repairs with primary open arch procedures followed by thoracic endovascular stenting.
This study reports a single-center retrospective review (2003 to 2016) of 118 patients undergoing hybrid repair of the aortic arch including 48 single-stage repairs versus 70 two-stage repairs.
Single-stage repair was performed in 48 patients, including 31 (64.6%) men and 17 (35.4%) women with a mean age of 64 ± 11 years and a 2-stage procedure was performed in 70 patients, including 42 (60%) men and 28 (40%) women with a mean age of 65.67 ± 13.3 years (p = 0.46). More emergent single-stage procedures were performed in 23 of 48 (47.9%) patients versus 2-stage procedures in 8 of 70 (11.43%) patients (p < 0.001). Between the single- and 2-stage groups, there was no difference in stroke (6.25% [3 of 48] versus 14.28% [10 of 70]; p = 0.23), spinal cord ischemia (4.16% [2 of 48] versus 5.7% [4 of 70]; p = 1.0), or 30-day mortality rate: 8 of 48 (16.7%) patients versus a combined 30-day mortality rate of the 2-stage procedure of 14.8% (4 of 70 [5.7%] at the first stage and 5 of 55 [9.1%] at the second stage; p = 0.56), respectively. After exclusion of the 30-day mortality, midterm survival was 86% at 1 to 2 years for single-stage patients versus 80% at 1 year and 46% at 2 years for the 2-stage patients (p = 0.0019).
Both single-stage and 2-stage hybrid arch replacements are effective approaches for treating complex aortic arch diseases. Early deaths and neurological outcomes in the single-stage group are comparable to those in the combined 2-stage group. Furthermore, in this series, patients who had a single-stage hybrid procedure had a higher survival rate at 2 years. |
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| Bibliography: | ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 |
| ISSN: | 0003-4975 1552-6259 |
| DOI: | 10.1016/j.athoracsur.2018.11.042 |