title: Hybrid aortic arch debranching with staged endovascular completion in DeBakey type I aortic dissection.
abstract: BACKGROUND
  We assess midterm results of a hybrid approach to DeBakey type I aortic dissection using a new multibranched Dacron graft to create, by relocation of the inflow openings to the arch vessels toward the aortic root, a new aortic arch for an easier and safer second-staged endovascular stent grafting of the distal thoracic aorta.
  
  
  METHODS
  From March 2006 to July 2008 24 patients with DeBakey type I aortic dissection underwent ascending aorta and aortic arch replacement with debranching of epiaortic vessels using a new prosthesis to create an optimal landing zone for possible subsequent endovascular stent grafting of the distal thoracic aorta. Fifteen patients, who postoperatively presented a residual patent distal false lumen, underwent a successful second-stage endovascular stent-graft implantation.
  
  
  RESULTS
  One patient died after the surgical stage while there was no death after the endovascular stage with hospital mortality of 4.2%. Follow-up confirmed complete thrombosis of the residual distal false lumen in 95.6% and partial thrombosis in 4.4% of patients with no evidence of endoleaks in the cases that required the endovascular procedure. Overall actuarial survival at 28 months is 92.1% ± 7.9% with 100% freedom from reoperation.
  
  
  CONCLUSIONS
  Hybrid treatment of DeBakey type I aortic dissection with aortic arch debranching, using a new multibranched prosthesis (Lupiae Graft; Vascutek Terumo Inc, Scotland, United Kingdom) is confirmed to facilitate the subsequent endovascular completion. Midterm results in terms of survival and distal false lumen thrombosis are satisfactory. Further study of this operation is warranted to confirm the effectiveness and the durability of this approach.
authors.affiliation: Department of Cardiovascular Disease, Città di Lecce Hospital, GVM Research and Care, Strada Provinciale per Arnesano, Lecce, Italy. antoninomarullo@hotmail.com
authors.forename: Antonino G M
authors.initials: AG
authors.lastname: Marullo
authors.forename: Samuele
authors.initials: S
authors.lastname: Bichi
authors.forename: Rocco A
authors.initials: RA
authors.lastname: Pennetta
authors.forename: Gerardo
authors.initials: G
authors.lastname: Di Matteo
authors.forename: Antonio M
authors.initials: AM
authors.lastname: Cricco
authors.forename: Luigi
authors.initials: L
authors.lastname: Specchia
authors.forename: Fausto
authors.initials: F
authors.lastname: Castriota
authors.forename: Giampiero
authors.initials: G
authors.lastname: Esposito
mesh_terms: D000784:Aortic Dissection / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D004210:Dissection / Q000379:methods*; D057510:Endovascular Procedures / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality; D006801:Humans; D021621:Imaging, Three-Dimensional; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011474:Prosthesis Design; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome