title: Outcomes of Antegrade Stent Graft Deployment During Hybrid Aortic Arch Repair.
abstract: BACKGROUND
  Complex aortic arch disease can be a formidable challenge and is often treated with a two-stage elephant trunk technique. We examined our experience with hybrid arch repair with combined zone 0 stent graft deployment.
  
  
  METHODS
  A retrospective review was conducted of all patients who underwent type 2 hybrid arch replacement and zone 0 antegrade endovascular stent graft deployments at a single university center from June 2010 to August 2015.
  
  
  RESULTS
  The review included 48 patients, 25 (52%) elective and 23 (48%) nonelective, with a mean ± SD age of 64 ± 11 years. Overall in-hospital mortality was 17% (8 of 48). Age exceeding 65 years (odds ratio, 9.5; 95% confidence interval, 1.2 to 36), preoperative international normalized ratio exceeding 1.3 (odds ratio, 14.2; 95% confidence interval, 2.1 to 95.87), and postoperative acute kidney injury (odds ratio, 5.6; 95% confidence interval, 1.1 to 29) were associated with in-hospital death. Postoperative stroke occurred in 3 patients (6%) and permanent paraplegia in 1 patient (2%). One (2%) patient underwent reoperation due to bleeding, and 6 patients (13%) experienced respiratory failure/reintubation. Acute kidney injury developed in 12 patients (25%), according to Acute Kidney Injury Network criteria, with 7 (14.6%) at stage 1 and 5 (10.4%) at stage 3. At the 1-year follow-up, type II endoleak developed in 2 of the 40 patients (5%), and 2 others required reoperation due to progression of chronic aortic dissection. Median follow-up time was 17 months (range, 1 to 63 months). The overall survival rate was 92% ± 0.04% at 6 months and 89% ± 0.05% at 1 and at 3 years.
  
  
  CONCLUSIONS
  Hybrid repair of complex aortic arch pathology with antegrade stent graft deployment can be performed safely with high technical success while obviating the need for a second operation. Reasonable midterm survival can be anticipated; however, older age, preoperative coagulopathy, and postoperative acute kidney injury are factors associated with poor outcome.
authors.affiliation: Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Florida, Gainesville, Florida.
authors.forename: Seyed Hossein
authors.initials: SH
authors.lastname: Aalaei-Andabili
authors.affiliation: Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, University of Florida, Gainesville, Florida.
authors.forename: Salvatore
authors.initials: S
authors.lastname: Scali
authors.affiliation: Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Florida, Gainesville, Florida.
authors.forename: Charles
authors.initials: C
authors.lastname: Klodell
authors.affiliation: Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Florida, Gainesville, Florida.
authors.forename: Teng
authors.initials: T
authors.lastname: Lee
authors.affiliation: Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Indiana University, Indianapolis, Indiana.
authors.forename: Philip
authors.initials: P
authors.lastname: Hess
authors.affiliation: Cardiovascular Surgical Services, Florida Hospital, Orlando, Florida.
authors.forename: Tomas
authors.initials: T
authors.lastname: Martin
authors.affiliation: Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, University of Florida, Gainesville, Florida.
authors.forename: Adam
authors.initials: A
authors.lastname: Beck
authors.affiliation: Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, University of Florida, Gainesville, Florida.
authors.forename: Robert
authors.initials: R
authors.lastname: Feezor
authors.affiliation: Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Florida, Gainesville, Florida.
authors.forename: Mahmoud
authors.initials: M
authors.lastname: Alhussaini
authors.affiliation: Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Florida, Gainesville, Florida.
authors.forename: George
authors.initials: G
authors.lastname: Arnaoutakis
authors.affiliation: Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Florida, Gainesville, Florida. Electronic address: thomas.beaver@surgery.ufl.edu.
authors.forename: Thomas
authors.initials: T
authors.lastname: Beaver
mesh_terms: D000368:Aged; D000784:Aortic Dissection / Q000401:mortality / Q000601:surgery*; D001013:Aorta, Thoracic / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000401:mortality / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods*; D057510:Endovascular Procedures / Q000379:methods*; D005260:Female; D005431:Florida / Q000453:epidemiology; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology*; D011474:Prosthesis Design; D012189:Retrospective Studies; D015607:Stents; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome