Hybrid surgery in the treatment of 147 patients with acute type A aortic dissection and aneurysm in a single center: A retrospective cohort study_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

HUANG Ritai , XU Genxing , LI Wei , WANG Yongyi ,  XUE Song

Department of Cardiovascular Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200127, P. R. China;

Corresponding author：

XUE Song, Email: xuesong64@163.com

Keywords：

Stanford type A aortic dissection; hybrid surgery; total arch replacement; cohort study

DOI：

10.7507/1007-4848.202011077

Video：

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Objective To explore the single-center experience of hybrid therapy in treatment of Stanford type A aortic dissection, and to make a comparison of the clinical results of this hybrid therapy with total arch replacement surgery in the same period.Methods From March 2017 to April 2020, 272 patients with Stanford type A aortic dissection underwent surgical treatment in our center, including 147 patients (126 males and 21 females) who received the aortic arch surgery. Among them, 106 patients underwent replacement of ascending aorta+aortic arch+stent trunk (total arch replacement group), while 41 patients underwent one-stop compound total arch type Ⅱ hybrid surgery (compound total arch replacement group). We tried to identify whether hybrid surgery really simplified total arch replacement surgery of the aortic dissection by comparing the operative mortality, postoperative complication rate, operative time, extracorporeal circulation time, etc.Results There was no statistical difference in preoperative clinical data or death rate between the two groups. However, blood transfusion (6.74±7.35 U vs. 4.65±6.87 U, P<0.05), postoperative respiratory insufficiency [16 (15.09%) vs. 2 (4.88%), P<0.05], and apoplexy [3 (2.83%) vs. 0, P<0.05], paraplegia [2 (1.89%) vs. 0, P<0.05], in the compound total arch replacement group was significantly better than those of the total arch replacement group. The compound total arch replacement group did not shorten the total operation time, but it was significantly better in terms of extracorporeal circulation time (175.50±55.70 min vs. 129.70±48.80 min, P<0.05), aortic block time (103.10±23.70 min vs. 49.70±30.10 min, P<0.05), and the time of stopping the circulation or avoiding stopping the circulation (32.10±7.20 min vs. 0 min, P<0.05). The postoperative mechanical ventilation time was shorter in the compound total arch group (62.60±31.70 h vs. 41.30±32.60 h, P<0.05), and the time of staying in ICU (124.50±61.50 h vs. 63.40±71.20 h, P<0.05) and the postoperative hospital stay (13.50±11.20 d vs. 9.20±7.20 d, P<0.05) were significantly shorter than those in the total replacement group. A total of 138 patients were followed up for 6-38 (15.8±6.4) months. There was no statistical difference in one-year mortality or three-year mortality (P>0.05).Conclusion Hybrid surgery shortens extracorporeal circulation time, while reduces or avoids the time of deep hypothermia circulatory arrest, the incidence of complications and the time of hospital stay. In conclusions, hybrid surgery simplifies the arch management of acute Stanford type A aortic dissection.

Citation： HUANG Ritai, XU Genxing, LI Wei, WANG Yongyi, XUE Song. Hybrid surgery in the treatment of 147 patients with acute type A aortic dissection and aneurysm in a single center: A retrospective cohort study. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2022, 29(8): 992-996. doi: 10.7507/1007-4848.202011077 Copy

1.	Iino K, Takago S, Saito N, et al. Total arch replacement and frozen elephant trunk for acute type A aortic dissection. J Thorac Cardiovasc Surg, 2020: S0022-5223(20)33094-4.
2.	Okita Y, Kumamaru H, Motomura N, et al. Current status of open surgery for acute type A aortic dissection in Japan. J Thorac Cardiovasc Surg, 2020: S0022-5223(20)33045-2.
3.	Hachiro K, Kinoshita T, Suzuki T, et al. Total arch replacement in patients with chronic kidney disease. J Card Surg, 2021, 36(2): 475-482.
4.	Sultan I, Aranda-Michel E, Bianco V, et al. Outcomes of carotid artery replacement with total arch reconstruction for type A aortic dissection. Ann Thorac Surg, 2021, 112(4): 1235-1242.
5.	Milewski RK, Szeto WY, Pochettino A, et al. Have hybrid procedures replaced open aortic arch reconstruction in high-risk patients? A comparative study of elective open arch debranching with endovascular stent graft placement and conventional elective open total and distal aortic arch reconstruction. J Thorac Cardiovasc Surg, 2010, 140(3): 590-597.
6.	Patel HJ, Nguyen C, Diener AC, et al. Open arch reconstruction in the endovascular era: Analysis of 721 patients over 17 years. J Thorac Cardiovasc Surg, 2011, 141(6): 1417-1423.
7.	Leacche M, Umakanthan R, Zhao DX, et al. Surgical update: Hybrid procedures, do they have a role? Circ Cardiovasc Interv, 2010, 3(5): 511-518.
8.	Mutsuga M, Tokuda Y, Narita Y, et al. Is Hybrid repair for an entire shaggy aorta feasible? Heart Lung Circ, 2021, 30(5): 765-772.
9.	Zhang J, Ma W, Chen J, et al. Distal remodeling after operations for extensive acute aortic dissection. Ann Thorac Surg, 2021, 112(1): 83-90.
10.	Liang S, Liu Y, Zhang B, et al. A comparison of frozen elephant trunk, aortic balloon occlusion, and hybrid repair for total arch replacement. Semin Thorac Cardiovasc Surg, 2021, 33(3): 667-675.
11.	Beckmann E, Martens A, Korte W, et al. Open total arch replacement with trifurcated graft and frozen elephant trunk. Ann Cardiothorac Surg, 2020, 9(3): 170-177.
12.	Zhang L, Yu C, Yang X, et al. Hybrid and frozen elephant trunk for total arch replacement in DeBakey type Ⅰ dissection. J Thorac Cardiovasc Surg, 2019, 158(5): 1285-1292.
13.	Shi F, Wang Z. Acute aortic dissection surgery: Hybrid debranching versus total arch replacement. J Cardiothorac Vasc Anesth, 2020, 34(6): 1487-1493.
14.	Smith HN, Boodhwani M, Ouzounian M, et al. Classification and outcomes of extended arch repair for acute Type A aortic dissection: A systematic review and meta-analysis. Interact Cardiovasc Thorac Surg, 2017, 24(3): 450-459.
15.	Papakonstantinou NA, Antonopoulos CN, Baikoussis NG, et al. Aortic arch reconstruction: Are hybrid debranching procedures a good choice? Heart Lung Circ, 2018, 27(11): 1335-1349.

1. Iino K, Takago S, Saito N, et al. Total arch replacement and frozen elephant trunk for acute type A aortic dissection. J Thorac Cardiovasc Surg, 2020: S0022-5223(20)33094-4.
2. Okita Y, Kumamaru H, Motomura N, et al. Current status of open surgery for acute type A aortic dissection in Japan. J Thorac Cardiovasc Surg, 2020: S0022-5223(20)33045-2.
3. Hachiro K, Kinoshita T, Suzuki T, et al. Total arch replacement in patients with chronic kidney disease. J Card Surg, 2021, 36(2): 475-482.
4. Sultan I, Aranda-Michel E, Bianco V, et al. Outcomes of carotid artery replacement with total arch reconstruction for type A aortic dissection. Ann Thorac Surg, 2021, 112(4): 1235-1242.
5. Milewski RK, Szeto WY, Pochettino A, et al. Have hybrid procedures replaced open aortic arch reconstruction in high-risk patients? A comparative study of elective open arch debranching with endovascular stent graft placement and conventional elective open total and distal aortic arch reconstruction. J Thorac Cardiovasc Surg, 2010, 140(3): 590-597.
6. Patel HJ, Nguyen C, Diener AC, et al. Open arch reconstruction in the endovascular era: Analysis of 721 patients over 17 years. J Thorac Cardiovasc Surg, 2011, 141(6): 1417-1423.
7. Leacche M, Umakanthan R, Zhao DX, et al. Surgical update: Hybrid procedures, do they have a role? Circ Cardiovasc Interv, 2010, 3(5): 511-518.
8. Mutsuga M, Tokuda Y, Narita Y, et al. Is Hybrid repair for an entire shaggy aorta feasible? Heart Lung Circ, 2021, 30(5): 765-772.
9. Zhang J, Ma W, Chen J, et al. Distal remodeling after operations for extensive acute aortic dissection. Ann Thorac Surg, 2021, 112(1): 83-90.
10. Liang S, Liu Y, Zhang B, et al. A comparison of frozen elephant trunk, aortic balloon occlusion, and hybrid repair for total arch replacement. Semin Thorac Cardiovasc Surg, 2021, 33(3): 667-675.
11. Beckmann E, Martens A, Korte W, et al. Open total arch replacement with trifurcated graft and frozen elephant trunk. Ann Cardiothorac Surg, 2020, 9(3): 170-177.
12. Zhang L, Yu C, Yang X, et al. Hybrid and frozen elephant trunk for total arch replacement in DeBakey type Ⅰ dissection. J Thorac Cardiovasc Surg, 2019, 158(5): 1285-1292.
13. Shi F, Wang Z. Acute aortic dissection surgery: Hybrid debranching versus total arch replacement. J Cardiothorac Vasc Anesth, 2020, 34(6): 1487-1493.
14. Smith HN, Boodhwani M, Ouzounian M, et al. Classification and outcomes of extended arch repair for acute Type A aortic dissection: A systematic review and meta-analysis. Interact Cardiovasc Thorac Surg, 2017, 24(3): 450-459.
15. Papakonstantinou NA, Antonopoulos CN, Baikoussis NG, et al. Aortic arch reconstruction: Are hybrid debranching procedures a good choice? Heart Lung Circ, 2018, 27(11): 1335-1349.

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Hybrid surgery in the treatment of 147 patients with acute type A aortic dissection and aneurysm in a single center: A retrospective cohort study

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