Long-Term Outcomes of Hybrid Technique of Complicated Type B Aortic Dissection.

BACKGROUND: The purpose of this study was to evaluate the midterm and long-term clinical outcomes of aortic implantation of stent grafts under direct vision (hybrid surgical treatment).

METHODS: From March 2009 to December 2014, 285 patients presented with type B aortic dissection. Of these, 35 complicated patients underwent hybrid surgical treatment. Self-designed stent grafts (Micropart Corp, Shanghai, China) were implanted under direct vision. Collected data included the surgical time, cerebral perfusion time, aortic clamping time, postoperative (before discharge) mechanical ventilation time, consciousness recovery time, time in intensive care unit, length of stay, computed tomography angiography before discharge, middle- and long-term complications, mortality, and endoleaks.

RESULTS: All of the 35 implantations were successful. There was no inhospital mortality, reexploration for hemorrhage, paraplegia, cerebral infarction, endoleaks, nor left subclavian artery occlusions. Computed tomography angiography before discharge showed complete thrombosis of the false lumen of the descending aortic in 34 patients. During the longer follow-up of 5.05 ± 3.61 years (range, 3.0 to 10), 3 patients were lost to follow-up. Three patients died during follow-up: 1 died in a traffic accident and 2 died of sudden death. The actuarial survival among all patients was 90.63% during the long-term follow-up. No events such as paraplegia, cerebral infarction, upper limb ischemia, endoleaks, or left subclavian artery ischemia were found. One patient had descending aneurysm at the distal stent graft and underwent another thoracic endovascular aortic repair without additional procedures.

CONCLUSIONS: For patients with complicated type B aortic dissection, implantation of a stent graft under direct vision (hybrid surgery) is easily performed and provides satisfactory middle- and long-term outcomes.