Cardiovascular and Thoracic Surgery

Biography

Biography: YC Chan

Abstract

Introduction: Hybrid procedures with combined open extra-anatomical supra-aortic bypasses and endovascular surgery are less invasive for patients with complex aortic arch pathology. The aim of this paper is to report patients who developed retrograde Type A aortic dissection following initially successful hybrid endovascular treatment.

Methods: Retrospective review of prospectively collected computerised departmental database. All patients with supra-aortic hybrid endovascular surgery and post-procedure retrograde Type A dissection were identified. Patient demographics, comorbid conditions, perioperative parameters, procedural details and post-operative complications were collected.

Results: We report 6 patients who developed retrograde Type A aortic dissection. All were elective cases, with 3 chronic dissecting aneurysms and 3 atherosclerotic aneurysms. All had one stage hybrid procedures: 2 patients had carotid-carotid bypass grafts, 1 had carotid-carotid-left subclavian bypass graft, and 3 had bypass grafts from ascending aorta to innominate artery and left carotid artery. Five patients had Cook Zenith thoracic stentgrafts (Cook®, Bloomington, USA), and 1 had Medtronic® Valiant stentgrafts (Medtronic Vascular Inc, Santa Rosa, USA). The retrograde Type A dissection occurred with sudden symptoms at day 5, 6, 10, 20, 105 and 128 respectively. There were 3 immediate fatalities and 2 patients treated conservatively deemed unfit for reintervention (one died at 9 month of pneumonia, and one remained alive at 7 months post-complication). One patient underwent successful emergency open surgery and survived.

Conclusion: Supra-aortic hybrid procedures in treating aortic arch pathology are not protective of retrograde Type A dissection, and patients with this post-operative complication inevitably have poor outcome, even with early diagnosis or treatment is delayed