title: Type II arch hybrid debranching procedure.
abstract: Management of aortic arch aneurysm and dissection continues to evolve as endovascular options play an increasing role in treating thoracic aortopathies. Although conventional open treatment of aortic arch disease with total arch replacement still remains the gold standard, in patients with old age and/or high comorbid disease index, there is significant associated morbidity and mortality. The hybrid arch procedure, which aims to minimize cardiopulmonary bypass and circulatory arrest times, is a particularly appealing surgical option in this cohort of patients. The hybrid arch concept essentially entails three main principles: (I) open debranching of the great vessels; (II) creation of proper proximal (zone 0 landing) and distal landing zones, and; (III) concomitant or delayed endovascular stent grafting of the aortic arch. The classification scheme for hybrid arch debranching procedures is based on the extent of proximal and distal landing zone reconstruction required, and thus the need and extent of cardiopulmonary bypass and circulatory arrest management strategies to be employed. In this illustrated article, we describe the details of the type II hybrid arch debranching procedure, where the ascending aorta and aortic arch pathology is typically treated by reconstruction of ascending aorta ﹢ arch vessel debranching, with concomitant antegrade stent grafting of the aortic arch.
authors: Division of Cardiovascular Surgery, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA.
authors: Prashanth
authors: P
authors: Vallabhajosyula
authors: Wilson Y
authors: WY
authors: Szeto
authors: Nimesh
authors: N
authors: Desai
authors: Caroline
authors: C
authors: Komlo
authors: Joseph E
authors: JE
authors: Bavaria
keywords: Hybrid arch repair; aortic aneurysm; debranching procedure; thoracic aortic endovascular stent grafting
references: J Thorac Cardiovasc Surg. 2010 Sep;140(3):590-7
references: 20723729
references: Ann Thorac Surg. 2009 Aug;88(2):482-9; discussion 489-90
references: 19632398
references: Semin Thorac Cardiovasc Surg. 2009 Winter;21(4):347-54
references: 20226349
references: J Card Surg. 2007 Mar-Apr;22(2):97-102; discussion 103-4
references: 17338740
references: J Thorac Cardiovasc Surg. 2010 Dec;140(6 Suppl):S77-80; discussion S86-91
references: 21092802
references: Circulation. 2005 Oct 25;112(17):2619-26
references: 16246961
references: J Thorac Cardiovasc Surg. 2009 Mar;137(3):627-34
references: 19258079
references: Ann Thorac Surg. 2008 Sep;86(3):787-96; discussion 787-96
references: 18721563
references: Ann Thorac Surg. 2007 Feb;83(2):S811-4; discussion S824-31
references: 17257932
references: Ann Thorac Surg. 2007 Feb;83(2):S796-8; discussion S824-31
references: 17257929