Hybrid debranching with endovascular repair for thoracoabdominal aneurysms: a comparison with open repair.
BACKGROUND
Hybrid visceral-renal debranching procedures with endovascular repair have recently been proposed as a less invasive alternative to conventional thoracoabdominal aortic aneurysm (TAAA) surgery. This study provides a concurrent assessment of hybrid and open TAAA repair.


METHODS
One hundred two consecutive patients (mean age, 63.0 years) underwent open (73) or hybrid (29) Crawford type 1 (19), 2 (50), or 3 (33) TAAA repair from 2000 to 2009. Hybrid debranching procedures were selected for patients considered poor operative risk for standard TAAA repair (27) or for patient preference (2). The TAAAs were fusiform atherosclerotic (68), dissection (30), or pseudoaneurysm (4). Fifty-seven patients (55.9%) had previously undergone aortic repair. Outcomes were analyzed with 100% follow-up (mean, 30.5 months).


RESULTS
Operative procedures were urgent or emergent in 16 (15.6%). Early mortality occurred in 13 (12.7%), and was independently predicted by use of hypothermic circulatory arrest (p = 0.005). Early morbidity included permanent paraplegia (12), stroke (1), need for dialysis (22), or tracheostomy (7). Independent correlates of a composite outcome comprised of early mortality and these early morbidities included an urgent-emergent presentation (p = 0.002) or open TAAA repair (p = 0.021). Kaplan-Meier survival was similar between open and hybrid TAAA groups (p = 0.88). Late mortality was independently predicted by the presence of diabetes (p = 0.052) or the need for dialysis at the time of TAAA repair (p < 0.001).


CONCLUSIONS
Hybrid debranching procedures may reduce early morbidity and yield similar late survival, even in a group considered high risk for open surgery. These data support the increasing utilization of a hybrid debranching and endovascular approach for patients requiring thoracoabdominal aneurysmectomy.
Patel
Himanshu J
HJ
Department of Surgery, University of Michigan Cardiovascular Center, Ann Arbor, Michigan, USA. hjpatel@med.umich.edu
Upchurch
Gilbert R
GR
Eliason
Jonathan L
JL
Criado
Enrique
E
Rectenwald
John
J
Williams
David M
DM
Deeb
G Michael
GM
D000368:Aged; D017130:Angioplasty / Q000379:methods*; D017544:Aortic Aneurysm, Abdominal / Q000401:mortality / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000401:mortality / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods* / Q000401:mortality; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods / Q000401:mortality; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000401:mortality; D011336:Probability; D012189:Retrospective Studies; D018570:Risk Assessment; D016019:Survival Analysis; D013908:Thoracotomy / Q000009:adverse effects / Q000379:methods; D016896:Treatment Outcome