title: Unusual inflow sources and device introduction sites in aortic arch debranching.
abstract: OBJECTIVE
  Aim of the study was to evaluate a single center experience on hybrid treatment for thoracic aortic diseases, including aortic arch and ascending aorta endografting needing a total debranching from descending thoracic aorta and an antegrade endograft deployment from left ventricle.
  
  
  METHODS
  Between January 2004 and December 2010 48 patients underwent thoracic aorta endografting, with coverage of at least one supra-aortic artery, because of atherosclerotic, dissecting and post-traumatic aneurysms or complications of previous aortic surgery. Supra-aortic trunks revascularization was obtained from ascending aorta, common carotid arteries and, in three cases, from descending thoracic aorta since the unavailability of common inflow sites. In three cases the antegrade endograft introduction through left ventricle (transapical approach, 2 cases) or ascending aorta (one case) was the only possibility for a safe deployment.
  
  
  RESULTS
  Three groups have been identified on the basis of the proximal landing zone. Group A (27 patients): zone 2; Group B (9 patients): zone 1; Group C (12 patients): zone 0. The 30 days mortality was respectively 7.4%, 0% and 16%. Post operative paraplegia occurred in the 7.4% of group A, respiratory insufficiency and infections were the main post-operative complications with an incidence reaching 30% in each group.
  
  
  CONCLUSIONS
  Hybrid procedures on aortic arch represent a possible treatment for cases unfit for open surgery despite the complication rates and mortality are not negligible. In selected cases, the endografting can be extended up to beyond the landing zone 0 where an antegrade transventricular endograft deployment and a supra-aortic perfusion from descending thoracic aorta represent a feasible option.
authors.affiliation: Department of Cardiac, Thoracic and Vascular Sciences, Vascular and Endovascular Surgery, University of Padua, Padua, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Deriu
authors.forename: F
authors.initials: F
authors.lastname: Grego
authors.forename: P
authors.initials: P
authors.lastname: Frigatti
authors.forename: G
authors.initials: G
authors.lastname: Gerosa
authors.forename: M
authors.initials: M
authors.lastname: Piazza
authors.forename: S
authors.initials: S
authors.lastname: Bonvini
authors.forename: C
authors.initials: C
authors.lastname: Maturi
authors.forename: M
authors.initials: M
authors.lastname: Antonello
authors.forename: M
authors.initials: M
authors.lastname: Menegolo
mesh_terms: D000368:Aged; D000714:Anastomosis, Surgical / Q000295:instrumentation; D000792:Angiography; D001013:Aorta, Thoracic / Q000503:physiopathology / Q000601:surgery*; D001018:Aortic Diseases / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D001783:Blood Flow Velocity; D019917:Blood Vessel Prosthesis Implantation / Q000295:instrumentation*; D004452:Echocardiography; D004867:Equipment Design; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006352:Heart Ventricles / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011474:Prosthesis Design; D012189:Retrospective Studies; D015899:Tomography, Emission-Computed, Single-Photon; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome