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

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish
Pages (from-to)1023-1030.e1
JournalJournal of Vascular Surgery
Volume70
Issue number4
DOIs
Publication statusPublished - 2019 Oct 1

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Thoracic Aorta
Stents
Endoleak
Aortic Diseases
Sudden Death
Hospital Mortality
Fistula
Dissection
Thorax
Survival Rate
Mortality
Incidence
Infection

All Science Journal Classification (ASJC) codes

  • Surgery
  • Cardiology and Cardiovascular Medicine

Cite this

Joo, H. C., Youn, Y. N., Kwon, J. H., Won, J. Y., Lee, D. Y., Ko, Y. G., ... Yoo, K. J. (2019). Late complications after hybrid aortic arch repair. Journal of Vascular Surgery, 70(4), 1023-1030.e1. https://doi.org/10.1016/j.jvs.2019.01.058
Joo, Hyun Chel ; Youn, Young Nam ; Kwon, Joon Ho ; Won, Jong Yun ; Lee, Do Yun ; Ko, Young Guk ; Choi, Donghoon ; Yoo, Kyung Jong. / Late complications after hybrid aortic arch repair. In: Journal of Vascular Surgery. 2019 ; Vol. 70, No. 4. pp. 1023-1030.e1.
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abstract = "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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Joo, HC, Youn, YN, Kwon, JH, Won, JY, Lee, DY, Ko, YG, Choi, D & Yoo, KJ 2019, 'Late complications after hybrid aortic arch repair', Journal of Vascular Surgery, vol. 70, no. 4, pp. 1023-1030.e1. https://doi.org/10.1016/j.jvs.2019.01.058

Late complications after hybrid aortic arch repair. / Joo, Hyun Chel; Youn, Young Nam; Kwon, Joon Ho; Won, Jong Yun; Lee, Do Yun; Ko, Young Guk; Choi, Donghoon; Yoo, Kyung Jong.

In: Journal of Vascular Surgery, Vol. 70, No. 4, 01.10.2019, p. 1023-1030.e1.

Research output: Contribution to journalArticle

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T1 - Late complications after hybrid aortic arch repair

AU - Joo, Hyun Chel

AU - Youn, Young Nam

AU - Kwon, Joon Ho

AU - Won, Jong Yun

AU - Lee, Do Yun

AU - Ko, Young Guk

AU - Choi, Donghoon

AU - Yoo, Kyung Jong

PY - 2019/10/1

Y1 - 2019/10/1

N2 - 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.

AB - 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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Joo HC, Youn YN, Kwon JH, Won JY, Lee DY, Ko YG et al. Late complications after hybrid aortic arch repair. Journal of Vascular Surgery. 2019 Oct 1;70(4):1023-1030.e1. https://doi.org/10.1016/j.jvs.2019.01.058