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
Disclosure • WAL: • Cook Medical: Grants, consultant • Medtronic Endovascular: Consultant • Off-label use of a commercial device
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
Elephant Trunk • Advantages: • Long, prosthetic proximal landing zone • Single stage option • Disadvantages: • Mobile, unsupported structure • Difficult to access • Uncertain long-term stability
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
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.
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