title: Hybrid aortic arch repair for dissecting aneurysm.
abstract: OBJECTIVE
  This study analyzed the outcome of a combined endovascular and debranching procedure for hybrid aortic arch repair in patients with chronic dissecting aortic aneurysms involving the aortic arch.
  
  
  METHODS
  We reviewed all consecutive patients who underwent hybrid aortic arch repair for dissecting aneurysm at the Arnaud de Villeneuve Hospital.
  
  
  RESULTS
  A total of 33 consecutive patients between March 2005 and September 2015 were included. Patients' mean age was 65.1 ± 12.2 years. Mean aneurysm diameter was 60.3 ± 14.2 mm. Patients were treated for aneurysm diameter 55 mm or greater (n = 28), aortic growth more than 1 cm/year (n = 3), or rupture (n = 2). Eleven complete supra-aortic debranchings were performed in zone 0, with 2 concomitant replacements of the ascending aorta. Partial aortic arch debranching was performed in 22 patients (zone 1 = 8; zone 2 = 14). Technical success was achieved in 97% of patients. There was no in-hospital death. One patient died of decompensated cirrhosis on day 20, resulting in a 30-day mortality of 3%. One patient had major cerebrovascular complications (3%). Spinal cord ischemia was observed in 1 patient (3%), with complete recovery after spinal fluid drainage. Retrograde dissection occurred in 1 patient (3%). After a mean follow-up of 24.3 months (range, 0.6-104.8 months), the overall mortality was 12% (n = 4) with 3 additional deaths. Endoleak was reported in 6 patients (18%), of whom 2 required reintervention. Overall, 8 reinterventions were performed (24%), with a mean time from intervention of 8.7 months (range, 1.2-24.6 months).
  
  
  CONCLUSIONS
  Hybrid aortic arch repair for dissecting aneurysm is associated with acceptable early and midterm major morbidity and mortality, even for patients treated in zone 0. However, given the high rate of reintervention and endoleak, close follow-up is required.
authors.affiliation: Department of Vascular and Thoracic Surgery, Arnaud de Villeneuve Hospital, Montpellier, France. Electronic address: elsafaure@hotmail.com.
authors.forename: Elsa Madeleine
authors.initials: EM
authors.lastname: Faure
authors.affiliation: Department of Vascular and Thoracic Surgery, Arnaud de Villeneuve Hospital, Montpellier, France.
authors.forename: Ludovic
authors.initials: L
authors.lastname: Canaud
authors.affiliation: Department of Vascular and Thoracic Surgery, Arnaud de Villeneuve Hospital, Montpellier, France.
authors.forename: Charles
authors.initials: C
authors.lastname: Marty-Ané
authors.affiliation: Department of Vascular and Thoracic Surgery, Arnaud de Villeneuve Hospital, Montpellier, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Alric
mesh_terms: D000368:Aged; D000784:Aortic Dissection / Q000175:diagnosis / Q000601:surgery*; D001013:Aorta, Thoracic / Q000000981:diagnostic imaging / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000175:diagnosis / Q000601:surgery*; D001027:Aortography; D001807:Blood Vessel Prosthesis; D057510:Endovascular Procedures / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D005602:France / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
keywords: aortic arch; aortic dissection; dissecting aneurysm; hybrid repair