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

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

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  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

  2. Disclosure • WAL: • Cook Medical: Grants, consultant • Medtronic Endovascular: Consultant • Off-label use of a commercial device

  3. 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

  4. Elephant Trunk • Advantages: • Long, prosthetic proximal landing zone • Single stage option • Disadvantages: • Mobile, unsupported structure • Difficult to access • Uncertain long-term stability

  5. 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

  6. 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.

  7. Demographics

  8. Preoperative

  9. Indications for Treatment

  10. Concomitant Surgeries (1st Stage)

  11. 1st Stage (Open Surgical) Intraoperative

  12. Perioperative Data

  13. Outcomes

  14. 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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