Minimally invasive hybrid surgery for Stanford B aortic dissection involving the aortic arch / 中华胸心血管外科杂志

ABSTRACT

Objective:To investigate the effect and safety of one-staged hybrid surgery in the treatment of complicated Stanford B aortic dissection.Methods:246 consecutive patients who underwent one-staged hybrid technique with complicated type B aortic dissection (cTBAD) between January 2014 and July 2020 were retrospectively reviewed. The perioperative mortality and morbidity of the hybrid technique was assessed and the early results of follow up were evaluated.Results:The mean age of patients was(57.1±11.2)years old, and 175 (71.1%) were male. There were 166 cases of left common carotid artery-left subclavian artery vessels bypass + TEVAR (A group), operation time(62±8)min, post-operated hospitalization(5.2±1.3)days; 62 cases of right common carotid artery-left common carotid artery vessels bypass+ left common carotid artery-left subclavian artery vessels bypass + TEVAR (B group), operation time(88±12)min, post-operated hospitalization(6.1±1.8)days; 18 cases of debranch + TEVAR, operation time(236±36)min, post-operated hospitalization(8.8±2.1)days. 246 patients underwent hybrid procedure successfully (The technique success rate was 100%). 1 patient(0.4%)with traumatic aortic dissection (with cerebral trauma) died after operation 7 days. The average follow-up period was 5 years(30.3±7.1)xmonths. 236 patients(96%) without endoleak, 10 patients(4%)with proximal endoleak, 5 patients with regular follow-up, 5 patients with surgical treatment during one year (3 patients with re-TEVAR; 2 patients with opening operation); 25 patients(10.2%)incision hematomas, all these patients settled with closely observing and conservative treatment, and all these patients without reintervention. The rate of second intervention was 2% (5/246) the patency of bridging vessel was 99.7% (343/344). There was no paraplegia and stroke during perioperative period.Conclusion:One-staged hybrid surgery has a good short-term and med-term efficacy and safety for complicated Stanford B aortic dissection.