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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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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Cw lee 1 pj hess 2 td martin 2 tm beaver 2 ct klodell 2 rj feezor 1 and wa lee 1

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

  • WAL:

    • Cook Medical: Grants, consultant

    • Medtronic Endovascular: Consultant

  • Off-label use of a commercial device


Background

Background

  • 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

  • Advantages:

    • Long, prosthetic proximal landing zone

    • Single stage option

  • Disadvantages:

    • Mobile, unsupported structure

    • Difficult to access

    • Uncertain long-term stability


Arch debranching

Arch Debranching

  • 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

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


Preoperative

Preoperative


Indications for treatment

Indications for Treatment


Concomitant surgeries 1 st stage

Concomitant Surgeries (1st Stage)


1 st stage open surgical intraoperative

1st Stage (Open Surgical) Intraoperative


Perioperative data

Perioperative Data


Outcomes

Outcomes


Conclusions

Conclusions

  • 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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