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Late complications after hybrid aortic arch repair

 Hyun-Chel Joo  ;  Young-Nam Youn  ;  Joon Ho Kwon  ;  Jong Yun Won  ;  Do Yun Lee  ;  Young-Guk Ko  ;  Donghoon Choi  ;  Kyung-Jong Yoo 
 JOURNAL OF VASCULAR SURGERY, Vol.70(4) : 1023-1030.e1, 2019 
Journal Title
Issue Date
Aortic arch ; Hybrid arch repair ; Late complication
OBJECTIVE: Although hybrid arch repair has gained widespread application as an alternative option for high-risk patients, concerns about its long-term durability remain an important issue. The aim of this study was to investigate late complications after hybrid arch repair. METHODS: From January 2002 to December 2017, hybrid arch repair was performed in 65 patients with aortic arch disease (median age, 66.1 years; range, 41-86 years). Hybrid arch repair was defined as debranching involving at least one supra-aortic vessel bypass and simultaneous or staged endovascular thoracic stent grafting. We retrospectively analyzed late complications including reintervention, open conversion, and aortic-related death. The median follow-up period was 60.1 months (range, 1-170 months). RESULTS: The in-hospital mortality rate was 6% (4/65). Except for early death (n = 4) and early open conversion (n = 2), late complications were observed in 25 patients (25/59 [42%]). The median time interval between the initial procedure and late complication was 36.6 months (range, 1-92 months). Late complications included delayed type I endoleak (n = 8), distal stent-induced new entry (n = 3), stent migration (n = 3), retrograde type A dissection (n = 2), aortopulmonary fistula (n = 2), aortoesophageal fistula (n = 1), stent fracture (n = 1), infection (n = 1), and sudden death (n = 4). Six of these patients (10%) underwent late open conversion. The overall survival rates at 3 years and 6 years were 71.1 ± 7.4% and 57.2 ± 11.3%, respectively. The aortic event-free rates at 3 years and 6 years were 52.1 ± 7.3% and 39.4 ± 10.3%, respectively. CONCLUSIONS: Late complications in hybrid arch repair occurred in a substantial proportion of patients during midterm follow-up. Regardless of zone type, the incidence of late complications was relatively high. This study suggests that timely reintervention and open conversion are important for rescuing patients, but repeated reinterventions and conservative strategies are not recommended. Aggressive management and life-long surveillance after hybrid arch repair are mandatory for better outcomes.
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Appears in Collections:
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
Ko, Young Guk(고영국) ORCID logo https://orcid.org/0000-0001-7748-5788
Kwon, Joon Ho(권준호) ORCID logo https://orcid.org/0000-0002-6178-7252
Won, Jong Yun(원종윤) ORCID logo https://orcid.org/0000-0002-8237-5628
Yoo, Kyung Jong(유경종) ORCID logo https://orcid.org/0000-0002-9858-140X
Youn, Young Nam(윤영남)
Lee, Do Yun(이도연)
Joo, Hyun Chel(주현철) ORCID logo https://orcid.org/0000-0002-6842-2942
Choi, Dong Hoon(최동훈) ORCID logo https://orcid.org/0000-0002-2009-9760
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