• William D T Kent, Jehangir J Appoo, Joseph E Bavaria, Eric J Herget, Patrick Moeller, Alberto Pochettino, and Jason K Wong.
• Division of Cardiac Surgery, Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada.
• J. Thorac. Cardiovasc. Surg.. 2014 Dec 1;148(6):2951-5.

ObjectiveTo review the early results of a less invasive, single-stage hybrid arch procedure involving replacement of the ascending aorta, arch debranching, and zone 0 antegrade stent graft deployment.MethodsBetween May 2007 and January 2012, 20 patients with both acute and chronic aortic pathology were managed at 2 institutions with a type 2 hybrid arch procedure. Indications included diffuse atherosclerotic aneurysm, false lumen expansion of chronic aortic dissections, penetrating atherosclerotic ulcer, and acute type A dissection. Mean age was 67 ± 16.8 years with a mean European System for Cardiac Operative Risk Evaluation II score of 29.5 ± 19.4. Postoperative clinical and imaging follow-up was complete to a mean 18.5 ± 15.3 months.ResultsSuccessful zone 0 stent graft deployment was achieved in all cases. There was 1 in-hospital mortality (5%). A second death occurred at 40 days postoperation. Other complications included a permanent neurologic deficit in 1 patient (5%), transient paraplegia in 4 patients (20%), and 3 patients had respiratory complications (15%). There were no cases of renal failure requiring dialysis. Stent-related complications were identified in 4 patients (20%), including 3 type I endoleaks, none of which were at zone 0. There was 1 type II endoleak and a case of stent infolding. Two patients required a second successful endografting procedure.ConclusionsThis single-stage hybrid arch procedure offers an alternative approach to complex diffuse aortic pathology involving the arch. Replacement of the ascending aorta provides a safe location for zone 0 stent graft deployment, eliminating complications of proximal deployment in a native diseased aorta.Copyright © 2014 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

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