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Comparison of open surgical versus hybrid endovascular repair for descending thoracic aortic aneurysms with distal arch involvement.

 Hyun-Chel Joo  ;  Young-Nam Youn  ;  Young-Guk Ko  ;  Donghoon Choi  ;  Jong Yun Won  ;  Do Yun Lee  ;  Kyung-Jong Yoo 
 Journal of Thoracic Disease, Vol.10(6) : 3548-3557, 2018 
Journal Title
 Journal of Thoracic Disease 
Issue Date
Hybrid surgery ; descending aorta ; distal arch aneurysm
Background: Our aim was to compare the efficacies of conventional open thoracotomy and hybrid endovascular technique in patients with descending thoracic aortic aneurysms involving the distal arch. Methods: Between January 2005 and December 2015, 125 consecutive patients with descending aneurysms involving distal arch underwent open repair via thoracotomy (n=79) or zone 1/2 hybrid endovascular repair (n=46). Surgeries entailing total arch replacement by elephant trunk technique (with sternotomy) and Zone 0 hybrid arch repairs were excluded. Early and late outcomes were compared using propensity scores and inverse-probability-of-treatment weighting (IPTW). Results: In-hospital mortality rates for open repair (10.1%) and hybrid repair (6.5%) did not differ significantly (P=0.49). Major adverse outcomes included stroke (11.4% vs. 8.7%), paraplegia (2.5% vs. 0.0%) and lung complications (19.0% vs. 6.5%). Once adjusted by IPTW, hospital mortality risk for conventional open repair (OR =4.396; P=0.086) tended to be higher, and there was significant risk of lung complications (OR =4.372; P=0.025). However, both techniques were similar in terms of 30-day mortality (OR =2.745; P=0.257), stroke (OR =2.134; P=0.217), paraplegia (OR =3.639; P=0.407), and midterm survival (OR =1.05; P=0.90). Freedom from reintervention at 10 years was significantly better for open repair (85.2%±7.1%) compared with the hybrid approach (46.3%±11.0%; OR =0.13; P<0.01). Conclusions: Hybrid arch repair conferred a significantly lower incidence of pulmonary complications, without benefitting perioperative mortality and stroke. However, open repair proved more reliable, showing greater durability. Long-term investigations are needed to confirm the viability and safety of hybrid repair as an alternative treatment in this setting.
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1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Radiology (영상의학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Thoracic and Cardiovascular Surgery (흉부외과학교실) > 1. Journal Papers
Yonsei Authors
고영국(Ko, Young Guk) ORCID logo https://orcid.org/0000-0001-7748-5788
원종윤(Won, Jong Yun) ORCID logo https://orcid.org/0000-0002-8237-5628
유경종(Yoo, Kyung Jong) ORCID logo https://orcid.org/0000-0002-9858-140X
윤영남(Youn, Young Nam)
이도연(Lee, Do Yun)
주현철(Joo, Hyun Chel) ORCID logo https://orcid.org/0000-0002-6842-2942
최동훈(Choi, Dong Hoon) ORCID logo https://orcid.org/0000-0002-2009-9760
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