Hybrid Arch for Acute Type A Aortic Dissection: When to Deploy the Endograft? Debate: Frozen versus Staged?

Jehangir J. Appoo; Akash Fichadiya; Holly N. Smith; Vamshi K. Kotha; Eric J. Herget; Alexander J. Gregory; Wilson Y. Szeto

doi:10.1055/s-0038-1669415

AORTA, Table of Contents

CC BY 4.0 · Aorta (Stamford) 2018; 06(05): 109-112
DOI: 10.1055/s-0038-1669415

Pro-Con Debate

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Hybrid Arch for Acute Type A Aortic Dissection: When to Deploy the Endograft? Debate: Frozen versus Staged?

Jehangir J. Appoo

¹Division of Cardiac Surgery, Libin Cardiovascular Institute, University of Calgary, Cumming School of Medicine, Calgary, Canada

,

Akash Fichadiya

¹Division of Cardiac Surgery, Libin Cardiovascular Institute, University of Calgary, Cumming School of Medicine, Calgary, Canada

,

Holly N. Smith

¹Division of Cardiac Surgery, Libin Cardiovascular Institute, University of Calgary, Cumming School of Medicine, Calgary, Canada

,

Vamshi K. Kotha

²Department of Diagnostic Imaging, University of Calgary, Cumming School of Medicine, Calgary, Canada

,

Eric J. Herget

²Department of Diagnostic Imaging, University of Calgary, Cumming School of Medicine, Calgary, Canada

,

Alexander J. Gregory

³Department of Anaesthesia, University of Calgary, Cumming School of Medicine, Calgary, Canada

,

Wilson Y. Szeto

⁴Division of Cardiac Surgery, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania

› Author Affiliations

Abstract

Advances in open and endovascular techniques have resulted in novel approaches to repair of acute Type A aortic dissection. Hybrid arch procedures involve open arch resection and stent grafting of the descending aorta with stent graft insertion in one of two ways: Frozen or Staged. In this article, pros and cons of the two different paradigms of emerging hybrid arch techniques for acute Type A aortic dissections are discussed.

Keywords

aortic dissection - TEVAR - hybrid arch

Full Text

References

References
1 Pape LA, Awais M, Woznicki EM. , et al. Presentation, diagnosis, and outcomes of acute aortic dissection: 17-year trends from the international registry of acute aortic dissection. J Am Coll Cardiol 2015; 66 (04) 350-358
2 Czerny M, Schoenhoff F, Etz C. , et al. The impact of pre-operative malperfusion on outcome in acute type A aortic dissection: results from the GERAADA registry. J Am Coll Cardiol 2015; 65 (24) 2628-2635
3 Geirsson A, Bavaria JE, Swarr D. , et al. Fate of the residual distal and proximal aorta after acute type A dissection repair using a contemporary surgical reconstruction algorithm. Ann Thorac Surg 2007; 84 (06) 1955-1964 , discussion 1955–1964
4 Geirsson A, Szeto WY, Pochettino A. , et al. Significance of malperfusion syndromes prior to contemporary surgical repair for acute type A dissection: outcomes and need for additional revascularizations. Eur J Cardiothorac Surg 2007; 32 (02) 255-262
5 Erbel R, Aboyans V, Boileau C. , et al; ESC Committee for Practice Guidelines; The Task Force for the Diagnosis and Treatment of Aortic Diseases of the European Society of Cardiology (ESC). 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. Eur Heart J 2014; 35 (41) 2873-2926
6 Appoo JJ, Bozinovski J, Chu MW. , et al; CCS/CSCS/CSVS Thoracic Aortic Disease Guidelines Committee. Canadian Cardiovascular Society/Canadian Society of Cardiac Surgeons/Canadian Society for Vascular Surgery Joint Position Statement on Open and Endovascular Surgery for Thoracic Aortic Disease. Can J Cardiol 2016; 32 (06) 703-713
7 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 (03) 450-459
8 Pochettino A, Brinkman WT, Moeller P. , et al. Antegrade thoracic stent grafting during repair of acute DeBakey I dissection prevents development of thoracoabdominal aortic aneurysms. Ann Thorac Surg 2009; 88 (02) 482-489 , discussion 489–490
9 Appoo JJ, Gregory AJ, Fichadiya A, Kotha VK, Herget EJ. Zone 2 arch replacement and staged thoracic endovascular aortic repair for acute type A aortic dissection. Ann Thorac Surg 2017; 104 (03) e299-e301
10 Marullo AG, Bichi S, Pennetta RA. , et al. Hybrid aortic arch debranching with staged endovascular completion in DeBakey type I aortic dissection. Ann Thorac Surg 2010; 90 (06) 1847-1853
11 Weng SH, Weng CF, Chen WY. , et al. Reintervention for distal stent graft-induced new entry after endovascular repair with a stainless steel-based device in aortic dissection. J Vasc Surg 2013; 57 (01) 64-71