title: The efficacy and short-term results of hybrid thoracic endovascular repair into the ascending aorta for aortic arch pathologies.
abstract: OBJECTIVE
  Conventional total aortic arch repair is a high-risk procedure, particularly for high-risk patients. Although endovascular treatment of aortic arch aneurysm is a recently induced procedure, only a few cases are indicated and outcomes are questionable. Here, we report on the early and short-term results of our surgical procedure, i.e. hybrid arch repair with supra-aortic debranching and endografting into the ascending aorta.
  
  
  METHODS
  Of the 514 patients who underwent arch repairs from 1997 to March 2012, 40 (28 males; mean age 74.4 years) were high-risk patients for whom hybrid arch repair of the ascending aortic landing zone was performed. Aortic pathologies included 31 degenerative aneurysms (including two ruptures), three type A dissections and four type B dissections. We performed supra-aortic debranching from the ascending aorta and endografting into the ascending aorta in 28 patients (including 10 patients with graft replacements and 3 patients with banding of the ascending aorta). For the 12 patients with an ascending aorta diameter of <36 mm, the chimney graft technique into the innominate artery was performed.
  
  
  RESULTS
  The 30-day mortality rate was 3%. Postoperative complications were as follows: stroke (0 patient), haemodialysis (1), prolonged mechanical ventilation (2) and spinal cord ischaemia (1). There were one early type I and two type II endoleaks. The mean follow-up duration was 15.5 months, during which freedom from aorta-related death and aortic events were 91 and 89% at 3 years.
  
  
  CONCLUSIONS
  We achieved satisfactory early and short-term results with hybrid arch repair into the ascending aorta. Our findings suggest that hybrid repair into the ascending aorta may be a viable option for high-risk patients with aortic arch pathologies.
authors.affiliation: Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Osaka, Japan.
authors.forename: Yukitoshi
authors.initials: Y
authors.lastname: Shirakawa
authors.forename: Toru
authors.initials: T
authors.lastname: Kuratani
authors.forename: Kazuo
authors.initials: K
authors.lastname: Shimamura
authors.forename: Kei
authors.initials: K
authors.lastname: Torikai
authors.forename: Tomohiko
authors.initials: T
authors.lastname: Sakamoto
authors.forename: Takayuki
authors.initials: T
authors.lastname: Shijo
authors.forename: Yoshiki
authors.initials: Y
authors.lastname: Sawa
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001013:Aorta, Thoracic / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods*; D057867:Endoleak / Q000209:etiology; D057510:Endovascular Procedures / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods*; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology; D012189:Retrospective Studies
keywords: Arch repair; Ascending aortic landing zone; Thoracic endovascular repair; Total debranching