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DOI: 10.1055/s-2004-816663
Stent-graft combined to debranching of the supra-aortic vessels: A less invasive approach to repair the aortic arch
Objectives: Surgical repair of the aortic arch requires cardiopulmonary bypass and deep hypothermic circulatory arrest which are responsible for a substantial morbidity. We present a combined surgical and endovascular approach that allows total exclusion of the aortic arch without extracorporeal circulation.
Material and Methods: Four high-risk patients (age 18, 69, 71 and 78 years) were selected for a complete (n=3) or partial (n=1) endovascular repair of the aortic arch. Lesions were: atherosclerotic aneurysm (n=2), grade IV atherosclerosis with recurrent cerebral embolization (n=1) and hypoplastic aortic arch/coarctation with multiple previous procedures. A bifurcated graft is constructed between the ascending aorta and the innominate and left carotid arteries. The left subclavian artery is either transposed to the left carotid artery or attached to the ascending aorta with an additional graft. The supra-aortic vessels are transected and oversewn at their aortic origin. The stent-graft is introduced in a retrograde fashion and deployed under fluoroscopy (proximal landing zone is the distal ascending aorta). Completion arteriography confirmed proper position of the stent-graft and complete exclusion of the lesion. Additional procedures included OPCAB in one and extra-anatomic ascending-to-descending bypass in another patient.
Results: The procedure was technically successful in all patients. Postoperative imaging demonstrated complete exclusion of the aortic arch lesion in all patients, and the clinical follow-up up to 12 months was uneventful.
Conclusions: Debranching of the supra-aortic vessels combined to endovascular stent-graft represents an attractive concept that eliminates cardiopulmonary bypass, deep hypothermia and circulatory arrest and their inherent risks. Durability of this repair has to be investigated in the long-term.