title: Hybrid procedures for complex aortic pathology: initial experience at a single center.
abstract: OBJECTIVE
  To review experience at our center with the use of hybrid techniques for treating complex aneurysms of the thoracic aorta.
  
  
  METHODS
  The medical records of 41 patients (40 male) with complex aortic aneurysms affecting supra-aortic or visceral vessels who underwent hybrid procedures between 1998 and 2007 were reviewed retrospectively. All patients were in American Society of Anesthesiologists category IV. They were divided in two groups: group A comprised 32 patients with aneurysms involving the aortic arch and its branches (2 ascending aorta replacements, 1 arch repair, 13 carotid-carotid bypasses, 12 carotid-subclavian bypasses, and 4 with total arch debranching); and group B comprised 9 patients with thoracoabdominal aneurysms and visceral vessel transpositions (4 partial and 5 total debranching). The mean age in group A was 69.3+/-1.3 (range, 62-73) years and in group B, 71.5+/-5.0 (range, 68-74) years.
  
  
  RESULTS
  The mean hospital stay was 18+/-7.1 days (range, 5-35) and 12+/-8.2 days (range, 2-15) in groups A and B, respectively. Overall mortality was 12.2% (3.4% and 44.4% in groups A and B, respectively) and neurological morbidity was 3.4% and 11.1% in the two groups, respectively.
  
  
  CONCLUSIONS
  The results obtained with hybrid treatment of the aortic arch area were comparable with those of conventional surgery. However, thoracoabdominal repair with complete revascularization of the visceral branches was associated with high mortality. Consequently, hybrid treatment is a valid option for high-risk patients who do not require complete revascularization in the visceral area.
authors.affiliation: División de Cirugía Vascular, Instituto del Tórax, Hospital Clínic, Universidad de Barcelona, Barcelona, Spain.
authors.forename: Marcio F Maciel
authors.initials: MF
authors.lastname: Da Rocha
authors.forename: Salvador
authors.initials: S
authors.lastname: Miranda
authors.forename: Domingo
authors.initials: D
authors.lastname: Adriani
authors.forename: Francesca
authors.initials: F
authors.lastname: Urgnani
authors.forename: Vicente A
authors.initials: VA
authors.lastname: Riambau
authors.forename: Jaime
authors.initials: J
authors.lastname: Mulet
mesh_terms: D000368:Aged; D017545:Aortic Aneurysm, Thoracic / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014656:Vascular Surgical Procedures / Q000379:methods