Abstract
Objectives: To compare the clinical outcomes of total debranching (TD) vs partial debranching (PD) for hybrid aortic arch repair. Methods: From May 2008 to April 2013, 77 patients underwent hybrid aortic arch repair for a variety of aortic pathologies. Total debranching was performed in 24 patients and partial debranching in 53 patients. Staged thoracic endovascular aortic repair (TEVAR) was carried out in 9 patients (TD group) and 13 patients (PD group). The length of proximal neck was 39±17 mm in TD patients and 29±9 mm in PD patients (p<0.05). Results: The early mortality rate was 4% (1/24) in the TD group and 2% (1/53) in the PD group. Respiratory failure developed in 25% (6/24) of TD patients and 4% (2/53) of PD patients (p<0.01). As for debranching and simultaneous TEVAR, hospital stay averaged 33±29 days in the TD group and 16±10 days in the PD group (p<0.001). Within 7 days, 3 patients (13%) undergoing TD had endoleak, while 18 patients (34%) undergoing PD experienced endoleak. Three patients of the PD group underwent endovascular revisions for endoleak. No patients of the TD group required surgical reintervention. Actual 2-year survival of the TD and PD cohort was 69±10% and 84±6%, respectively. Event-free survival of the TD and PD group was 59±11% and 73±6%, respectively. Conclusion: Although TD technique is more invasive than PD technique, the former allows a better landing zone.
