Hybrid repair of aortic arch aneurysm in high-risk patients.
OBJECTIVE
Morbidity and mortality after conventional surgery of aortic arch aneurysms remain high. Alternative techniques are the subject of this report.


RESULTS
Open surgery requires cardiopulmonary bypass and hypothermic circulatory arrest. Thoracic endovascular aneurysm repair has a less invasive therapeutic alternative. The number of high-risk patients has considerably increased over the past decade. The proximity of the aneurysm to the supraaortic vessels makes it difficult to achieve a satisfactory proximal landing zone for endovascular stenting. Two methods have been proposed to address this issue: branched stent grafts and extraanatomic bypass, defined as a hybrid approach, which combines aortic debranching and endovascular procedures. Experience with hybrid repair is limited. Today there are no formal guidelines for the management of aortic arch aneurysm in high-risk patients.


CONCLUSIONS
Hybrid repair of aortic arch aneurysm in high-risk patients is a feasible and safer option.
Campanella
Antonio
A
Department of Cardiothoracic Surgery, Division of Cardiac Surgery, Italy. antoniocampanella@libero.it
Rinaldi
Mauro
M
Rispoli
Pietro
P
Gandini
Giovanni
G
D000368:Aged; D017545:Aortic Aneurysm, Thoracic / Q000000981:diagnostic imaging / Q000601:surgery*; D001027:Aortography / Q000379:methods; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation; D057510:Endovascular Procedures / Q000009:adverse effects / Q000295:instrumentation; D006801:Humans; D008297:Male; D017410:Practice Guidelines as Topic; D018570:Risk Assessment; D015607:Stents; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome