• Yukitoshi Shirakawa, Toru Kuratani, Kazuo Shimamura, Kei Torikai, Tomohiko Sakamoto, Takayuki Shijo, and Yoshiki Sawa.
• Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Osaka, Japan.
• Eur J Cardiothorac Surg. 2014 Feb 1;45(2):298-304; discussion 304.

ObjectivesConventional total aortic arch repair is a high-risk procedure, particularly for high-risk patients. Although endovascular treatment of aortic arch aneurysm is a recently induced procedure, only a few cases are indicated and outcomes are questionable. Here, we report on the early and short-term results of our surgical procedure, i.e. hybrid arch repair with supra-aortic debranching and endografting into the ascending aorta.MethodsOf the 514 patients who underwent arch repairs from 1997 to March 2012, 40 (28 males; mean age 74.4 years) were high-risk patients for whom hybrid arch repair of the ascending aortic landing zone was performed. Aortic pathologies included 31 degenerative aneurysms (including two ruptures), three type A dissections and four type B dissections. We performed supra-aortic debranching from the ascending aorta and endografting into the ascending aorta in 28 patients (including 10 patients with graft replacements and 3 patients with banding of the ascending aorta). For the 12 patients with an ascending aorta diameter of <36 mm, the chimney graft technique into the innominate artery was performed.ResultsThe 30-day mortality rate was 3%. Postoperative complications were as follows: stroke (0 patient), haemodialysis (1), prolonged mechanical ventilation (2) and spinal cord ischaemia (1). There were one early type I and two type II endoleaks. The mean follow-up duration was 15.5 months, during which freedom from aorta-related death and aortic events were 91 and 89% at 3 years.ConclusionsWe achieved satisfactory early and short-term results with hybrid arch repair into the ascending aorta. Our findings suggest that hybrid repair into the ascending aorta may be a viable option for high-risk patients with aortic arch pathologies.

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