title: Hybrid proximal surgery plus adjunctive retrograde endovascular repair in acute DeBakey type I dissection: superior outcomes to conventional surgical repair.
abstract: OBJECTIVE
  The present study compared the outcomes between conventional surgery and the hybrid approach of proximal surgery with adjunctive retrograde descending aortic endografting plus distal bare metal stenting in acute DeBakey type I dissection.
  
  
  METHODS
  From 2003 to 2011, 61 patients underwent surgical management for acute type A aortic dissection at our institution. Of these, 37 were DeBakey type I dissections: 18 patients (group 1) received conventional surgical repair alone, and 19 (group 2) underwent conventional hybrid surgery with adjunctive retrograde descending aortic stent grafting plus distal bare metal stenting.
  
  
  RESULTS
  The patients' baseline characteristics were comparable, including the incidence of preoperative malperfusion syndromes (P = .23). The intraoperative and postoperative characteristics were similar, except 4 (22%) patients in group 1 (vs 0 in group 2) had ongoing malperfusion postoperatively (P = .04). Overall, hospital mortality was 11% (n = 2) for group 1 versus 5% (n = 1) for group 2. At a mean follow-up of 50 months, 4 (25%) subjects in group 1 required secondary thoracoabdominal aortic reintervention versus none in group 2 (P = .03).
  
  
  CONCLUSIONS
  The use of adjunctive retrograde descending aortic endografting plus distal bare metal stenting during acute DeBakey type 1 dissection repair is a feasible method to enhance thoracoabdominal remodeling. This hybrid strategy improves perioperative outcomes and decreases late distal aortic complications compared with conventional surgical repair for acute DeBakey type I dissection. A prospective, multicenter study is warranted to definitively assess this promising new treatment paradigm.
authors.affiliation: Department of Medicine, St. Vincent's Hospital Melbourne, University of Melbourne, Fitzroy, Victoria, Australia. s.hofferberth@ugrad.unimelb.edu.au
authors.forename: Sophie C
authors.initials: SC
authors.lastname: Hofferberth
authors.forename: Andrew E
authors.initials: AE
authors.lastname: Newcomb
authors.forename: Michael Y
authors.initials: MY
authors.lastname: Yii
authors.forename: Kelvin K
authors.initials: KK
authors.lastname: Yap
authors.forename: Raymond C
authors.initials: RC
authors.lastname: Boston
authors.forename: Ian K
authors.initials: IK
authors.lastname: Nixon
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Mossop
mesh_terms: D000328:Adult; D000368:Aged; D000784:Aortic Dissection / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D001027:Aortography / Q000379:methods; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation / Q000401:mortality; D057510:Endovascular Procedures / Q000009:adverse effects / Q000295:instrumentation / Q000401:mortality; D005240:Feasibility Studies; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008670:Metals; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality / Q000601:surgery; D011474:Prosthesis Design; D012086:Reoperation; D012189:Retrospective Studies; D015607:Stents; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D008670:Metals