Arch Debranching versus Elephant Trunk Procedures for Hybrid Repair of Proximal Thoracic Aortic Path...
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CW Lee 1 , PJ Hess 2 , TD Martin 2 , TM Beaver 2 , CT Klodell 2 , RJ Feezor 1 and WA Lee 1 - PowerPoint PPT Presentation


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Arch Debranching versus Elephant Trunk Procedures for Hybrid Repair of Proximal Thoracic Aortic Pathologies. CW Lee 1 , PJ Hess 2 , TD Martin 2 , TM Beaver 2 , CT Klodell 2 , RJ Feezor 1 and WA Lee 1

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Arch Debranching versus Elephant Trunk Procedures for Hybrid Repair of Proximal Thoracic Aortic Pathologies

CW Lee1, PJ Hess2, TD Martin2, TM Beaver2, CT Klodell2, RJ Feezor1 and WA Lee1

Divisions of Vascular Surgery and Endovascular Therapy1 and Thoracic and Cardiovascular Surgery2

University of Florida, Gainesville


Disclosure
Disclosure Repair of Proximal Thoracic Aortic Pathologies

  • WAL:

    • Cook Medical: Grants, consultant

    • Medtronic Endovascular: Consultant

  • Off-label use of a commercial device


Background
Background Repair of Proximal Thoracic Aortic Pathologies

  • Hybrid (1st stage: open surgical + 2nd stage: endovascular) repairs of complex arch diseases are feasible and effective

  • Optimal technique (elephant trunk vs. arch debranching) for creation of a suitable proximal landing zone for endovascular repair remains undecided


Elephant trunk
Elephant Trunk Repair of Proximal Thoracic Aortic Pathologies

  • Advantages:

    • Long, prosthetic proximal landing zone

    • Single stage option

  • Disadvantages:

    • Mobile, unsupported structure

    • Difficult to access

    • Uncertain long-term stability


Arch debranching
Arch Debranching Repair of Proximal Thoracic Aortic Pathologies

  • Advantages:

    • Long, native proximal landing zone

    • Single stage option

  • Disadvantages:

    • A short, dilated ascending aorta may require ascending replacement and/or trans-valvular insertion

    • 3-vessel debranching can be challenging

    • Risk of ascending dissection


Objective methods
Objective & Methods Repair of Proximal Thoracic Aortic Pathologies

Arch Debranching vs. Elephant Trunk

+

Endovascular Stent Graft

  • Retrospective review of consecutive patients with proximal thoracic aortic pathologies

  • Prospective database, imaging, medical records

  • Categorical variables were compared using Fisher’s exact test. Continuous variables with nonparametric distribution were compared using the Mann-Whitney U test. A p-value <0.05 was considered significant.


Demographics
Demographics Repair of Proximal Thoracic Aortic Pathologies


Preoperative
Preoperative Repair of Proximal Thoracic Aortic Pathologies


Indications for treatment
Indications for Treatment Repair of Proximal Thoracic Aortic Pathologies


Concomitant surgeries 1 st stage
Concomitant Surgeries (1 Repair of Proximal Thoracic Aortic Pathologiesst Stage)


1 st stage open surgical intraoperative
1 Repair of Proximal Thoracic Aortic Pathologiesst Stage (Open Surgical) Intraoperative


Perioperative data
Perioperative Data Repair of Proximal Thoracic Aortic Pathologies


Outcomes
Outcomes Repair of Proximal Thoracic Aortic Pathologies


Conclusions
Conclusions Repair of Proximal Thoracic Aortic Pathologies

  • Arch debranching was associated with:

    • Less frequent need for CPB/circulatory arrest

    • Shorter overall LOS

    • Earlier 2nd stage completion

    • One-third the incidence of proximal endoleaks


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