Clinical effect of ascending aorta banding combined with typeⅠ hybrid aortic arch repair on aortic arch diseases_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

MA Jinhui ¹ , ZHANG Lanlin ² , YANG Sheng ² , DONG Songbo ² , CHEN Yu ² , PAN Xudong ² , XU Shangdong ² ,  ZHENG Jun ²

1. Department of Vascular Surgery, Henan Provincial People’s Hospital, People’s Hospital of Zhengzhou University, People’s Hospital of Henan University, Zhengzhou, 450003, P. R. China;
2. Department of Cardiovascular Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing Aortic Disease Centre, Beijing, 100029, P. R. China;

Corresponding author：

ZHENG Jun, Email: dr.zhengjun@hotmail.com

Keywords：

Hybrid procedure; ascending aorta banding; thoracic endovascular aortic repair; aortic arch diseases

DOI：

10.7507/1007-4848.202211084

Video：

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Objective To assess the efficacy and safety of ascending aorta banding technique combined with typeⅠhybrid aortic arch repair for the aortic arch diseases. Methods The clinical data of patients undergoing ascending aorta banding technique combined with type Ⅰ hybrid arch repair for aortic arch diseases from March 2019 to March 2022 in Beijing Anzhen Hospital were retrospectively analyzed. The technical success, perioperative complications and follow-up results were evaluated. Results A total of 44 patients were collected, including 35 males and 9 females, with a median age of 63.0 (57.5, 64.6) years. The average EuroSCORE Ⅱ score was 8.4%±0.7%. The technical success rate was 100.0%. All patients did not have retrograde type A aortic dissection and endoleaks. One patient died of multiple organ failure 5 days after operation, the in-hospital mortality rate was 2.3%, and the remaining 43 patients survived and were discharged from hospital. The median follow-up period was 14.5 (6-42) months with a follow-up rate of 100.0%. One patient with spinal cord injury died 2 years after hospital discharge. One patient underwent thoracic endovascular aortic repair at postoperative 3 months due to new entry tears near to the distal end of the stent. Conclusion Ascending aorta banding combined with typeⅠhybrid arch repair for the aortic arch diseases does not need cardio-pulmonary bypass. Ascending aorta banding technique strengthens the proximal anchoring area of the stent to avoid risks such as retrograde type A dissection, endoleak and migration. The operation owns small trauma, rapid recovery, low mortality and a low rate of reintervention, which may be considered as a safe and effective choice in the treatment of the elderly, high-risk patients with complex complications.

Citation： MA Jinhui, ZHANG Lanlin, YANG Sheng, DONG Songbo, CHEN Yu, PAN Xudong, XU Shangdong, ZHENG Jun. Clinical effect of ascending aorta banding combined with typeⅠ hybrid aortic arch repair on aortic arch diseases. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2024, 31(9): 1313-1318. doi: 10.7507/1007-4848.202211084 Copy

1.	Buczkowski P, Puslecki M, Stefaniak S, et al. Off pump hybrid extra-anatomic techniques for aortic arch repair-own experience. J Thorac Dis, 2019, 11(6): 2305-2314.
2.	Gaudry M, Porto A, Blanchard A, et al. A 10-year aortic center experience with hybrid repair of chronic "residual" aortic dissection after type A repair. Cardiovasc Drugs Ther, 2022, 36(2): 285-294.
3.	国家心血管病专家委员会血管外科专业委员会. 杂交技术治疗累及弓部主动脉病变的中国专家共识. 中国循环杂志, 2020, 35(2): 124-130.National Society of Vascular Surgery, China. Chinese expert consensus on hybrid technique on treating thoracic aortic pathologies involving the aortic arch. Chin Circ J, 2020, 35(2): 124-130.
4.	Erbel R, Aboyans V, Boileau C, et al. 2014 ESC guidelines on the diagnosis and treatment of aortic diseases: Document covering acute and chronic aortic diseases of the thoracic and abdominal aorta of the adult. The Task Force for the Diagnosis and Treatment of Aortic Diseases of the European Society of Cardiology (ESC). Eur Heart J, 2014, 35(41): 2873-2926.
5.	Yamamoto K, Komori K, Narita H, et al. A 'through-and-through bowing technique' for antegrade thoracic endovascular aneurysm repair with total arch debranching: A technical note and the initial results. Eur J Cardiothorac Surg, 2016, 49(4): 1264-1269.
6.	Czerny M, Weigang E, Sodeck G, et al. Targeting landing zone 0 by total arch rerouting and TEVAR: Midterm results of a transcontinental registry. Ann Thorac Surg, 2012, 94(1): 84-89.
7.	Banno H, Mutsuga M, Sugimoto M, et al. Midterm outcomes of zone 0 antegrade endograft implantation during type Ⅰ hybrid aortic arch repair. Eur J Vasc Endovasc Surg, 2021, 61(6): 938-944.
8.	Kudo T, Kuratani T, Shimamura K, et al. Determining the optimal proximal landing zone for TEVAR in the aortic arch: Comparing the occurrence of the bird-beak phenomenon in zone 0 vs zones 1 and 2. J Endovasc Ther, 2020, 27(3): 368-376.
9.	Ranney DN, Yerokun BA, Benrashid E, et al. Outcomes of planned two-stage hybrid aortic repair with dacron-replaced proximal landing zone. Ann Thorac Surg, 2018, 106(4): 1136-1142.
10.	Piffaretti G, Trimarchi S, Gelpi G, et al. Hybrid repair of extensive thoracic aortic aneurysms. Eur J Cardiothorac Surg, 2020, 58(5): 940-948.
11.	De Rango P, Ferrer C, Coscarella C, et al. Contemporary comparison of aortic arch repair by endovascular and open surgical reconstructions. J Vasc Surg, 2015, 61(2): 339-346.
12.	Kudo T, Kuratani T, Shimamura K, et al. Long-term results of hybrid aortic arch repair using landing zone 0: A single-centre study. Eur J Cardiothorac Surg, 2021, 59(6): 1227-1235.
13.	Hsu HL, Huang CY, Chen PL, et al. Efficacy of ascending aortic banding technique concomitant with type Ⅰ hybrid aortic arch repair in high-risk patients. Heart Vessels, 2019, 34(9): 1524-1532.
14.	梁凯, 逯党辉, 张志东, 等. HybridⅡ型主动脉弓修复术在Stanford A型主动脉夹层的应用分析. 中华血管外科杂志, 2014, 46(1): 32-39.Liang K, Lu DH, Zhang ZD, et al. Application analysis of type Ⅱ aortic arch hybrid debranching procedure in Stanford type A aortic dissection. Chin J Vasc Surg, 2014, 46(1): 32-39.
15.	Iba Y, Minatoya K, Matsuda H, et al. How should aortic arch aneurysms be treated in the endovascular aortic repair era? A risk-adjusted comparison between open and hybrid arch repair using propensity score-matching analysis. Eur J Cardiothorac Surg, 2014, 46(1): 32-39.
16.	Tokuda Y, Oshima H, Narita Y, et al. Hybrid versus open repair of aortic arch aneurysms: Comparison of postoperative and mid-term outcomes with a propensity score-matching analysis. Eur J Cardiothorac Surg, 2016, 49(1): 149-156.
17.	Preventza O, Tan CW, Orozco-Sevilla V, et al. Zone zero hybrid arch exclusion versus open total arch replacement. Ann Cardiothorac Surg, 2018, 7(3): 372-379.
18.	Moulakakis KG, Mylonas SN, Markatis F, et al. A systematic review and meta-analysis of hybrid aortic arch replacement. Ann Cardiothorac Surg, 2013, 2(3): 247-260.
19.	Leontyev S, Tsagakis K, Pacini D, et al. Impact of clinical factors and surgical techniques on early outcome of patients treated with frozen elephant trunk technique by using EVITA open stent-graft: Results of a multicentre study. Eur J Cardiothorac Surg, 2016, 49(2): 660-666.
20.	Sandhu HK, Evans JD, Tanaka A, et al. Fluctuations in spinal cord perfusion pressure: A harbinger of delayed paraplegia after thoracoabdominal aortic repair. Semin Thorac Cardiovasc Surg, 2017, 29(4): 451-459.
21.	Pellenc Q, Roussel A, Senemaud J, et al. Staged hybrid repair of type Ⅱthoracoabdominal aneurysms. J Vasc Surg, 2021, 74(1): 20-27.

1. Buczkowski P, Puslecki M, Stefaniak S, et al. Off pump hybrid extra-anatomic techniques for aortic arch repair-own experience. J Thorac Dis, 2019, 11(6): 2305-2314.
2. Gaudry M, Porto A, Blanchard A, et al. A 10-year aortic center experience with hybrid repair of chronic "residual" aortic dissection after type A repair. Cardiovasc Drugs Ther, 2022, 36(2): 285-294.
3. 国家心血管病专家委员会血管外科专业委员会. 杂交技术治疗累及弓部主动脉病变的中国专家共识. 中国循环杂志, 2020, 35(2): 124-130.National Society of Vascular Surgery, China. Chinese expert consensus on hybrid technique on treating thoracic aortic pathologies involving the aortic arch. Chin Circ J, 2020, 35(2): 124-130.
4. Erbel R, Aboyans V, Boileau C, et al. 2014 ESC guidelines on the diagnosis and treatment of aortic diseases: Document covering acute and chronic aortic diseases of the thoracic and abdominal aorta of the adult. The Task Force for the Diagnosis and Treatment of Aortic Diseases of the European Society of Cardiology (ESC). Eur Heart J, 2014, 35(41): 2873-2926.
5. Yamamoto K, Komori K, Narita H, et al. A 'through-and-through bowing technique' for antegrade thoracic endovascular aneurysm repair with total arch debranching: A technical note and the initial results. Eur J Cardiothorac Surg, 2016, 49(4): 1264-1269.
6. Czerny M, Weigang E, Sodeck G, et al. Targeting landing zone 0 by total arch rerouting and TEVAR: Midterm results of a transcontinental registry. Ann Thorac Surg, 2012, 94(1): 84-89.
7. Banno H, Mutsuga M, Sugimoto M, et al. Midterm outcomes of zone 0 antegrade endograft implantation during type Ⅰ hybrid aortic arch repair. Eur J Vasc Endovasc Surg, 2021, 61(6): 938-944.
8. Kudo T, Kuratani T, Shimamura K, et al. Determining the optimal proximal landing zone for TEVAR in the aortic arch: Comparing the occurrence of the bird-beak phenomenon in zone 0 vs zones 1 and 2. J Endovasc Ther, 2020, 27(3): 368-376.
9. Ranney DN, Yerokun BA, Benrashid E, et al. Outcomes of planned two-stage hybrid aortic repair with dacron-replaced proximal landing zone. Ann Thorac Surg, 2018, 106(4): 1136-1142.
10. Piffaretti G, Trimarchi S, Gelpi G, et al. Hybrid repair of extensive thoracic aortic aneurysms. Eur J Cardiothorac Surg, 2020, 58(5): 940-948.
11. De Rango P, Ferrer C, Coscarella C, et al. Contemporary comparison of aortic arch repair by endovascular and open surgical reconstructions. J Vasc Surg, 2015, 61(2): 339-346.
12. Kudo T, Kuratani T, Shimamura K, et al. Long-term results of hybrid aortic arch repair using landing zone 0: A single-centre study. Eur J Cardiothorac Surg, 2021, 59(6): 1227-1235.
13. Hsu HL, Huang CY, Chen PL, et al. Efficacy of ascending aortic banding technique concomitant with type Ⅰ hybrid aortic arch repair in high-risk patients. Heart Vessels, 2019, 34(9): 1524-1532.
14. 梁凯, 逯党辉, 张志东, 等. HybridⅡ型主动脉弓修复术在Stanford A型主动脉夹层的应用分析. 中华血管外科杂志, 2014, 46(1): 32-39.Liang K, Lu DH, Zhang ZD, et al. Application analysis of type Ⅱ aortic arch hybrid debranching procedure in Stanford type A aortic dissection. Chin J Vasc Surg, 2014, 46(1): 32-39.
15. Iba Y, Minatoya K, Matsuda H, et al. How should aortic arch aneurysms be treated in the endovascular aortic repair era? A risk-adjusted comparison between open and hybrid arch repair using propensity score-matching analysis. Eur J Cardiothorac Surg, 2014, 46(1): 32-39.
16. Tokuda Y, Oshima H, Narita Y, et al. Hybrid versus open repair of aortic arch aneurysms: Comparison of postoperative and mid-term outcomes with a propensity score-matching analysis. Eur J Cardiothorac Surg, 2016, 49(1): 149-156.
17. Preventza O, Tan CW, Orozco-Sevilla V, et al. Zone zero hybrid arch exclusion versus open total arch replacement. Ann Cardiothorac Surg, 2018, 7(3): 372-379.
18. Moulakakis KG, Mylonas SN, Markatis F, et al. A systematic review and meta-analysis of hybrid aortic arch replacement. Ann Cardiothorac Surg, 2013, 2(3): 247-260.
19. Leontyev S, Tsagakis K, Pacini D, et al. Impact of clinical factors and surgical techniques on early outcome of patients treated with frozen elephant trunk technique by using EVITA open stent-graft: Results of a multicentre study. Eur J Cardiothorac Surg, 2016, 49(2): 660-666.
20. Sandhu HK, Evans JD, Tanaka A, et al. Fluctuations in spinal cord perfusion pressure: A harbinger of delayed paraplegia after thoracoabdominal aortic repair. Semin Thorac Cardiovasc Surg, 2017, 29(4): 451-459.
21. Pellenc Q, Roussel A, Senemaud J, et al. Staged hybrid repair of type Ⅱthoracoabdominal aneurysms. J Vasc Surg, 2021, 74(1): 20-27.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Clinical effect of ascending aorta banding combined with typeⅠ hybrid aortic arch repair on aortic arch diseases

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