• Heinz Jakob, Daniel-Sebastian Dohle, Jarowit Piotrowski, Jaroslav Benedik, Matthias Thielmann, Guenter Marggraf, Raimund Erbel, and Konstantinos Tsagakis.
• Department of Thoracic and Cardiovascular Surgery, West-German Heart Center, University of Duisburg-Essen, Essen, Germany. heinz.jakob@uk-essen.de
• Eur J Cardiothorac Surg. 2012 Dec 1; 42 (6): 1018-25.

ObjectivesTo avoid a two-stage surgical approach for complex thoracic aortic disease with its additive mortality and morbidity, a hybrid stent graft prosthesis was introduced 6 years ago for simultaneous treatment of the ascending, arch and descending aortas, relying proximally on a surgical suture line with an integrated distal stent graft for downstream splinting. We report the mid-term single-centre experience.MethodsBetween January 2005 and March 2011, 77 patients (mean age 59 years, male 75%) with acute (AAD, n = 39) or chronic aortic dissection (CAD, n = 23) DeBakey type I or an extensive thoracic aortic aneurysm (TAA, n = 15) underwent one-stage repair. Periodic follow-up studies (100%, mean 29 months) included repeat aortic computed tomography imaging. Major adverse events (MAEs) were defined as permanent stroke, spinal cord injury and dialysis.ResultsIn-hospital mortality was 10% (8 of 77). The incidence of MAE in AAD, CAD and TAA was 5, 13 and 20%, respectively. At the last follow-up, the complete thrombosis of the thoracic false lumen was 92% for AAD, 91% for CAD and the full exclusion of aneurysms 100% in TAA. Throughout the follow-up, freedom from aortic disease-related death was 93% and 5-year survival 79%. Freedom from distal reoperation was 94% in AAD, 95% in CAD and 100% in TAA and the incidence of distal stent graft extension 10% (8 of 77).ConclusionsThe durable hybrid one-stage repair of complex thoracic aortic disease is feasible with acceptable mortality. Distal reintervention is infrequent and associated with low risk; thus, the indication for the optimization of the peripheral flow using the endovascular aortic repair techniques is gradually widened.

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