title: Aortic hemiarch hybrid repair.
abstract: BACKGROUND
  Hybrid aortic arch reconstruction represents a treatment option for patients unsuitable for conventional open cardiovascular surgery. We analyzed patient outcome after hemiarch repair in zone 1 and zone 2 with regard to early and long-term results.
  
  
  METHODS
  Between December 2004 and December 2012, a total of 47 patients underwent hemiarch repair for distal aortic arch disease. Supra-aortic debranching was performed in 23 patients for zone 1 (carotid-carotid crossover bypass) and in 24 patients for zone 2 (carotid-subclavian bypass/subclavian transposition) followed by thoracic endovascular aortic repair. All patients included had been refused for open surgery or were emergency cases.
  
  
  RESULTS
  Mean age of the patients was 65.3 years; 51% of patients were symptomatic or presented with a contained aortic rupture. Overall technical success rate was 81%, with a 30-day mortality rate of 12.8%. A primary type Ia endoleak was observed in 19%. The mean follow-up period was 50.5 months (range, 1-93 months). Follow-up mortality was 14.9%; secondary endoleak rate was 8.5% for both groups. There was a trend of reduced primary type Ia endoleak rate for zone 2 repair compared with zone 1 (4.3% vs 14.9%; P = .07). Follow-up mortality was also improved for zone 2 repair (4.3% vs 10.6%; P = .41). Overall survival rate was 70%.
  
  
  CONCLUSIONS
  Hemiarch hybrid repair in high-risk patients is associated with an acceptable perioperative mortality risk and long-term survival. Zone 2 represents a feasible and effective treatment option for hybrid arch repair. Zone 1 is related with relevant risk for type Ia endoleak and higher mortality during follow-up. Lifelong surveillance after hybrid repair is essential.
authors.affiliation: Department of Vascular Surgery, Lucerne Cantonal Hospital, Lucerne, Switzerland; Department for Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University Munich, Munich, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Ockert
authors.affiliation: Department for Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University Munich, Munich, Germany.
authors.forename: Georg
authors.initials: G
authors.lastname: Eckstein
authors.affiliation: Department for Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University Munich, Munich, Germany.
authors.forename: Brigitta
authors.initials: B
authors.lastname: Lutz
authors.affiliation: Department for Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University Munich, Munich, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Reeps
authors.affiliation: Department for Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University Munich, Munich, Germany. Electronic address: HHEckstein@web.de.
authors.forename: Hans-Henning
authors.initials: HH
authors.lastname: Eckstein
mesh_terms: D000368:Aged; D000792:Angiography; D001013:Aorta, Thoracic / Q000601:surgery*; D001018:Aortic Diseases / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery; D057867:Endoleak / Q000209:etiology; D057510:Endovascular Procedures; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome