title: Debranching solutions in endografting for complex thoracic aortic dissections.
abstract: BACKGROUND
  Conventional surgical repair of thoracic aortic dissections is a challenge due to mortality and morbidity risks.
  
  
  OBJECTIVE
  We analyzed our experience in hybrid aortic arch repair for complex dissections of the aortic arch.
  
  
  METHODS
  Between 2009 and 2013, 18 patients (the mean age of 67 ± 8 years-old) underwent hybrid aortic arch repair. The procedural strategy was determined on the individual patient.
  
  
  RESULTS
  Thirteen patients had type I repair using trifurcation and another patient with bifurcation graft. Two patients had type II repair with replacement of the ascending aorta. Two patients received extra-anatomic bypass grafting to left carotid artery allowing covering of zone 1. Stent graft deployment rate was 100%. No patients experienced stroke. One patient with total debranching of the aortic arch following an acute dissection of the proximal arch expired 3 months after TEVAR due to heart failure. There were no early to midterm endoleaks. The median follow-up was 20 ± 8 months with patency rate of 100%.
  
  
  CONCLUSIONS
  Various debranching solutions for different complex scenarios of the aortic arch serve as less invasive procedures than conventional open surgery enabling safe and effective treatment of this highly selected subgroup of patients with complex aortic pathologies.
authors.affiliation: Cardiovascular Surgery, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey.
authors.forename: Onur Selcuk
authors.initials: OS
authors.lastname: Goksel
authors.affiliation: Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey.
authors.forename: Koray
authors.initials: K
authors.lastname: Guven
authors.affiliation: Mustafa Kemal Medical Faculty, Istanbul, Turkey.
authors.forename: Celalettin
authors.initials: C
authors.lastname: Karatepe
authors.affiliation: Cardiovascular Surgery, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey.
authors.forename: Emre
authors.initials: E
authors.lastname: Gok
authors.affiliation: Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey.
authors.forename: Bulent
authors.initials: B
authors.lastname: Acunas
authors.affiliation: Medical Park Hospital, Istanbul, Turkey.
authors.forename: Bayer
authors.initials: B
authors.lastname: Cinar
authors.affiliation: Cardiovascular Surgery, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey.
authors.forename: Ufuk
authors.initials: U
authors.lastname: Alpagut
mesh_terms: D000368:Aged; D000784:Aortic Dissection / Q000000981:diagnostic imaging / Q000601:surgery*; D001013:Aorta, Thoracic / Q000000981:diagnostic imaging / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000000981:diagnostic imaging / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000379:methods*; D017023:Coronary Angiography; D057867:Endoleak; D057510:Endovascular Procedures / Q000379:methods; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D012307:Risk Factors; D015607:Stents; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome