Hybrid Aortic Arch Debranching and TEVAR Is Safe in a Private, Community Hospital.

BACKGROUND: Hybrid open cervical vessel debranching and thoracic endovascular aortic repair (TEVAR) is a treatment option in the management of aortic arch or proximal descending thoracic aortic aneurysms. However, these patients are often referred to tertiary care academic centers for aneurysm repair. Our study looks to assess the safety and outcomes of open cervical debranching and TEVAR within a private, community hospital setting. METHODS: A total of 12 patients underwent hybrid open cervical vessel debranch with staged TEVAR from 2015 to 2018 at Riverside Community Hospital (Riverside, California). Three patients underwent open sternotomy with innominate artery bypass; four patients underwent combined carotid-carotid bypass with left carotid-axillary bypass or left subclavian transposition; three patients solely underwent left carotid-axillary bypass or left subclavian transposition. In cases involving multiple cervical bypasses, two surgeons were present. TEVAR was performed in a staged fashion during the same hospitalization. RESULTS: There were no patient deaths, MI, or stroke within the 30-day postoperative period and at 1-year follow-up. One patient suffered a small subdural bleed after ascending aorta to innominate bypass involving redo sternotomy and hypothermic circulatory arrest. The mean aortic zone stented was zone 1. On follow-up imaging, all bypass grafts were patent, all aneurysms demonstrated thrombosis without endoleak. Average follow-up was 20 months. CONCLUSIONS: Hybrid cervical debranching with staged TEVAR can be safely performed by experienced vascular surgeons in the community setting. Staged repair appears to confer better operative and patient outcomes.

Poor outcome and quality of life in female patients undergoing secondary surgery for recurrent peptic ulcer disease.

Secondary peptic ulcer surgery is uncommon given the success of a wide variety of medical therapies, plus the good outcome expected after primary peptic ulcer surgery. Early reports of secondary peptic ulcer surgery in the 1950s and 1960s suggested good long-term outcome in most patients; however, recent data suggest that patients operated in the Helicobacter pylori era have a worse outcome. We have attempted to quantify the poor outcome in these patients and measure the effect of sex, a previously unrecognized risk factor for poor outcome after peptic ulcer surgery. We reviewed the outcomes of 35 patients who underwent secondary peptic ulcer surgery for symptoms of persistent or recurrent peptic ulcer symptoms or complications of the condition. These patients were compared to a "control" group of patients to determine long-term quality of life as measured by the SF-36 and Visick scores (average follow-up 60 months). Visick and SF-36 scores were obtained through telephone interviews. The two groups of patients were age matched to eliminate age as a variable in the SF-36 results. There were more females than males in the secondary peptic ulcer surgery group (4.5/1 female-to-male ratio). Although perioperative mortality was zero for both groups, patients undergoing secondary peptic ulcer surgery had a high number of complications (57% of patients had complications). Patients undergoing secondary peptic ulcer surgery scored lower in seven of the eight subclasses of the SF-36 questionnaire compared to their age-matched cohorts. In contrast, average Visick scores showed slight improvement for three out of four symptoms reported. Immediate postoperative complications were not related to long-term quality of life issues. Secondary peptic ulcer surgery is more prevalent in females than in males. Although secondary peptic ulcer surgery is partially effective in alleviating symptoms, quality of life is poor.