Hybrid Repair of the Aortic Arch
Hybrid Arch Repair
Hybrid repair of the aorta is a new less-invasive treatment which combines the advantages of open aortic surgery with endovascular aortic stents and endografts. This technique was developed to provide treatment of complex aortic aneurysms and dissections which involve the aortic arch. The aortic arch is a portion of the aorta located high in the chest at the base of the neck and contains important branches to the head and arms.
Standard aortic surgery for the aortic arch involves a sternotomy (incision the entire length of the breast bone) and connecting the heart to the heart and lung machine (cardiopulmonary bypass circuit). In addition, a process called circulatory arrest is instituted which involves temporarily stopping blood flow in the head and body. This technique allows for surgical replacement of the aortic arch with a synthetic Dacron tube with branches to the great vessels (head and arm blood vessels).
Hybrid arch repair involves opening the chest in the same fashion as for standard aortic arch surgery. The heart is kept beating during hybrid arch repair and does not need to be stopped or connected to the heart-lung machine. Surgical bypasses are performed from the ascending aorta to each of the great vessels which maintains blood flow to the brain and arms. Following the bypasses, and endovascular aortic stent, or aortic endograft, is inserted into the aorta and deployed from the ascending aorta around the aortic arch. This excluded the aortic arch aneurysm while permitting blood flow to the brain. The endovascular portion of the procedure is performed using X-ray guidance. The stent in the aorta can be delivered either directly through the chest or seperately from an artery in the groin. In addition, the bypass and stent procedures can be completed during the same surgery or staged.
Aortic stent combined with surgical bypasses to the great vessels
CT scan of the aortic arch following hybrid arch repair for a patient with an aortic dissection and aneurysm.
The advantages of this type of minimally invasive surgery are that it combines the advantages of standard surgical principles with new aortic stent-graft technology. The operative risks are comparable to traditional arch repair, but the recovery is quicker due to the less-invasive nature of the procedure. Because this is a relatively new treatment, few centers have much experience with this approach. Frequently, patients with aortic arch disease are older and sicker with more health problems and sometimes aren't candidates for standary arch repair. Hybrid arch repair can often provide another treatment option for these high-risk patients.